0BRTH BB1T 



STARR. 



LIBRARY OF CONGRESS, 



ji. .X^Aeopgrigfjl !Qo. 

Sheli 

__ _] W» 

UNITED STATES OF AMERICA. 



! 



HYGIENE OF THE NURSERY 



STARR 



Other Books by Dr. Starr. 



THE DIGESTIVE ORGANS IN CHILDHOOD. 

The Diseases of the Digestive Organs in Infancy and 
Childhood. With Chapters on the Investigation of Dis- 
ease, the Management of Children, Massage, etc. Second 
Edition. With Lithograph Plates and Wood Engravings. 
Revised and Enlarged. i2mo. Cloth, $2.50 

DISEASES OF CHILDREN. New Edition. The 
Student's Guide to the Diseases of Children. By J. F. 
Goodhart, M.D., f.r.c.p., Physician to Evelina Hospital 
for Children, Demonstrator of Morbid Anatomy at Guy's 
Hospital, London. Edited, with notes and additions, by 
Louis Starr, m.d. Second Edition. Revised, Enlarged 
and Rearranged. Cloth, $3.00; Leather, $3.50. 

P. Blakiston, Son & Co., Publishers, 

IOI2 Walnut Street, Philadelphia. 



HYGIENE 



OF 



THE NURSERY 



INCLUDING THE GENERAL REGIMEN AND FEEDING OF 
INFANTS AND CHILDREN; MASSAGE, AND THE 
DOMESTIC MANAGEMENT OF THE ORDI- 
NARY EMERGENCIES OF EARLY LIFE. 



BY 



LOUIS STARR, M.D., 



LATE CLINICAL PROFESSOR OF DISEASES OF CHILDREN IN THE HOSPITAL OF 

THE UNIVERSITY OF PENNSYLVANIA ; PHYSICIAN TO THE CHILDREN'S 

HOSPITAL ; CONSULTING PODIATRIST TO THE MATERNITY 

HOSPITAL, PHILADELPHIA, ETC. 



FOURTH EDITION. 



WITH TWENTY-FIVE ILLUSTRATIONS. 



X<^ OF COAvN. 

161894 

PHILADELPHIA: V^ kash^S^ 
P. BLAKISTON, SON & co '->\j#3ZZ, 

IOI2 WALNUT STREET. 
I894. 






Copyright, 1894, by Louis Starr, m.d. 



or »h r rsu. a co . 

f!0-*4 »AMftOM MRCET, 



TO 
MY LITTLE PATIENTS, 

SOME OF WHOM, 

IN THE RAPID PASSING OF TIME, MAY SOON ASSUME 
PARENTAL DUTIES, 

THIS VOLUME 
IS AFFECTIONATELY DEDICATED. 



PREFACE TO THE FOURTH EDITION 



The sheets of this, the fourth, edition of the 
Hygiene of the Nursery have been thoroughly re- 
vised and altered wherever necessary to keep abreast 
with the advances constantly being made in the 
methods of managing infants and children. 

The author would call especial attention to a new 

process of preparing and preserving cow's milk, 

known as " Pasteurization/' which now, for the first 

time, finds a place in the " Hygiene." This is a 

simple method of sterilization at a low temperature 

and without pressure that is far superior to, and 

more universally applicable than, the old process of 

" Sterilization" at a high heat under pressure, which, 

while a great advance at the time of its discovery 

and of marked value under proper conditions, has 

been too indiscriminately employed, either to the 

disappointment of the physician and parents, or 

to the distinct detriment of the infant's health — a 

most serious result. 

LOUIS STARR. 
1818 Rittenhouse Square, 

Philadelphia, December, 1893. 



Vll 



PREFACE TO THE SECOND EDITION. 



The very flattering reception of the first edition 
of the Hygiene of the Nursery has encouraged its 
reintroduction to the public. 

In the preparation of the second issue the original 
matter has been thoroughly revised, and numerous 
additions have been made. 

The author must again acknowledge the assist- 
ance of Dr. Allen J. Smith and the most effective 
aid of Dr. W. M. Powell. 

LOUIS STARR. 

Philadelphia, April, 1889. 



vi u 



PREFACE TO THE FIRST EDITION, 



Having a firm belief in the proverb that "an 
ounce of prevention is worth a pound of cure," the 
author has endeavored, in the succeeding pages, to 
point out a series of hygienic rules which, . if 
applied to the nursling, can hardly fail to maintain 
good health, give vigor to the frame and so lessen 
susceptibility to disease. 

He feels, too, that intelligent parents are ever 
ready to be instructed and willing to cooperate in 
the great work of preventing disease — the highest 
aim of scientific medicine. 

While every woman of ordinary brain-power can 
do much to keep her baby well, she should recog- 
nize that years of training and experience are 
necessary to acquire the ability to put the full value 
upon symptoms, and to handle the tools of medi- 
cine. Therefore, little or no reference has been 
made to drugs or methods of medical treatment. 

The first chapter is written with the object of 

ix 



X PREFACE TO THE FIRST EDITION. 

hinting to the mother when, by deviations from the 
features of health, she may expect the onset of dis- 
ease and call in professional counsel. The last is 
offered, not as a complete guide to the practice of 
physic, but simply for the sake of giving informa- 
tion upon questions that often arise in the nursery. 

The child's doctor, in our day, regulates his 
patient's diet, clothing, bathing and exercise, and 
looks into the hygiene of the nursery before he 
orders medicines, and if the mother has sound ideas 
upon these subjects she is no mean assistant. 

The author's thanks are due to Dr. W. M. 
Powell for efficient aid in the preparation of the 
manuscript and index, and to Dr. Allen J. Smith 
for the illustrations. 

LOUIS STARR. 

Philadelphia, September -, 1888. 



CONTENTS 



CHAPTER I. PAGK 

The Features of Health, 17 

CHAPTER II. 
The Nursery, 62 

CHAPTER III. 
The Nurse-Maid, 80 

CHAPTER IV. 
Clothing, 85 

CHAPTER V. 
Exercise and Amusements, 107 

CHAPTER VI. 
Sleep, 119 

CHAPTER VII. 
Bathing, - 125 

CHAPTER VIII. 
Food, 150 

CHAPTER IX. 
Dietary, 213 

CHAPTER X. 
Massage, 236 

CHAPTER XI. 
Emergencies, 248 

Index. 287 

xi 



HYGIENE OF THE NURSERY 



CHAPTER I. 

THE FEATURES OF HEALTH. 

Every ill child presents certain well-defined alter- 
ations in the manner of performance of the various 
functions of his body. Thus, the pulse and respi- 
ration may be altered in character and frequency ; 
the surface temperature may be elevated ; the color 
and condition of the skin may be changed; the 
appetite may be diminished; weight may be lost, 
and so on. These alterations from the normal state 
are termed symptoms. 

Healthy children, on the other hand, as uniformly 
show evidences of their well-being, which, for want 
of a better name, may be called the features of 
health. Of these, every mother should have a full 
knowledge, so that by appreciating variations she 
may anticipate the complete development of disease, 
and early summon skilled aid, at the time when it 
is of most service. 

Early life must be divided into two periods, 
namely, infancy and childhood. Infancy is the 

17 



1 8 HYGIENE OF THE NURSERY. 

time elapsing between birth and the complete 
eruption of the milk teeth, an event that transpires 
about the end of the second year of life. Child- 
hood extends from this age to the development of 
puberty, or to the age of thirteen or fifteen years. 
It is important to remember these two divisions, as 
frequent reference will be made to them in the 
subsequent pages. 

With this brief preparation, the study of the 
features of health may be entered upon. 

i. The Face. — The face of a healthy, sleeping 
child wears an expression of absolute repose. The 
eyelids are completely closed, the lips very slightly 
parted, and, though a faint sound of rhythmical 
breathing may be heard, there is no visible move- 
ment of the nostrils. When awake and undisturbed, 
the healthy infant's face has a look of wondering 
observation of whatever is going on about it. As 
age advances, intelligence gradually supplants the 
wondering gaze, and no one can be unfamiliar with 
the bright, round, happy face of perfect childhood, 
so indicative of careless contentment, and so mobile 
in response to emotions. 

Examples of Variations in Disease. — Incomplete 
closure of the eyelids, rendering the whites of the 
eyes visible during sleep, is a symptom in all acute 
and chronic diseases of a severe type ; it is also to 
be observed when rest is rendered unsound by 



THE FEATURES OF HEALTH. I 9 

pain, wherever seated. Twitching of the eyelids, 
associated with oscillation of the eyeballs or 
squinting, herald the visit of convulsions. Widening 
of the orifices of the nose with movements of the 
nostrils to and fro, point to embarrassed breathing 
from disease of the lungs or their pleural invest- 
ment. Contraction of the brows indicates pain in 
the head ; sharpness of the nostrils, pain in the 
chest, and a drawn upper lip, pain in the abdomen. 
To make a general rule, it may be stated, that the 
upper third of the face is altered in expression in 
affections of the brain ; the middle third in diseases 
of the chest, and the lower third in diseases of the 
organs contained in the abdominal cavity. 

2. The Skin and General Appearance. — In the 
new-born infant the color of the skin varies from 
a deep to a light shade of red. After the first 
week this redness fades away, leaving the surface 
yellowish-white. At times this yellow color is so 
marked that it might be mistaken for jaundice were 
it not that the whites of the eyes remain perfectly 
pearly, which is never the case in the disease men- 
tioned. After the second week all discoloration 
disappears and the skin assumes its typical appear- 
ance. 

With certain well-known natural variations in 
complexion the skin of a healthy child is beauti- 
fully white and transparent. The cheeks, palms of 



20 HYGIENE OF THE NURSERY. 

the hands and soles of the feet have a delicate pink 
color, while the general surface is rosy in a warm 
atmosphere and marbled with faint blue spots or 
lines in a cold one. As age advances the coloring 
becomes more pronounced, and until the comple- 
tion of childhood the complexion is much fresher 
than in adult life. 

Other characters of the healthy skin are, a 
velvety smoothness and softness, a scarcely per- 
ceptible moisture, and a great degree of elasticity. 

If an infant be stripped the large size of the head 
and trunk, and the relatively short arms and even 
shorter legs, will strike the observer at once. This 
disproportion, especially noticeable in the head, is 
an actual one. For if in a child of one year, for 
example, the distance from the lower edge of the 
chin to the top of the head be measured, it will be 
found to be equal to one-fourth of the entire length 
of the body. The vertical length of the head, too, 
falls but little short of that of the trunk, and the 
latter in turn is nearly as long as the legs. 

Again, the abdomen is full and prominent, making 
the chest look, in comparison, rather contracted and 
narrow, and the navel is less deeply sunken than in 
adults. 

These features, which will be referred to more 
minutely in a later section, are most marked in 
young infants, and undergo gradual alterations as 



THE FEATURES OF HEALTH. 21 

growth progresses and the child develops into the 
lithe, active youth or maiden. 

The shape of the head varies greatly between 
the round, bullet form and the elongated oval one. 
When it has been subjected to much pressure, 
instrumental or otherwise, during delivery, it is 
often so distorted as to shock the expectant mother. 
Little fear of permanent disfigurement need be 
entertained, however, as the deformed head usually 
assumes a natural shape in time. The same is true 
of less noticeable depressions, prominences and 
irregularities. But it should be remembered that 
restoration to symmetry must be left entirely to 
nature, as any attempt to mould the skull by pres- 
sure rarely fails to injure the delicate brain beneath. 

The anterior fontanelle, or, as it is called by 
nurses, " the opening of the head/' is readily seen 
and felt in infants under a year old. In the nor- 
mal state it is level with, or very slightly depressed 
below, the surrounding bones of the skull, and 
may be observed to pulsate, or rise and fall, 
rhythmically. It is soft to the touch and yields 
readily to pressure. 

Examples of Variations in Disease. — Lividity of 
the eyelids and lips is a sign of imperfect oxidiza- 
tion of the blood, and points to disease of the 
heart or lungs. A decided yellow color of the 
skin and whites of the eyes is seen in jaundice; an 



22 



HYGIENE OF THE NURSERY. 



earthy tinge of the face, in long-standing disease of 
the bowels ; a waxy pallor in kidney disease, and 
paleness in any acute or chronic affection attended 
by exhaustion. 

Marked squareness of the head with projection 
of the forehead, a widely-open fontanelle, and a 

Fig. i. 




DIAGRAM SHOWING SHAPE OF HEADS. 

a, Normal head ; b, Hydrocephalic head ; c, Rickety head. 



relatively small face indicate rickets. A very large, 
globular head is characteristic of hydrocephalus or 
11 water on the brain ;" bulging of the fontanelle is 
also a symptom of this disease. In this connection 
it must be observed, however, that certain children 
are born with relatively large, globe-shaped heads, 



THE FEATURES OF HEALTH. 23 

though in every respect healthy. The peculiarity 
is especially apt to be observed when one of the 
parents — notably the father — has the same charac- 
teristic. In order to indicate disease, the deformity 
must be marked and combined with a widely open, 
bulging fontanelle, or with indications of impaired 
brain activity. Depression of the fontanelle shows 
general debility and the need of food or stimulants. 

The accompanying diagram, Fig. I, will aid in 
explaining this subject. 

Great distention of the abdomen is usually due 
to an accumulation of gas in the intestines, and 
indicates disease of this portion of the digestive 
tract; marked depression, on the other hand, is 
encountered in serious brain affections, in cholera 
infantum, inflammation of the intestines and dys- 
entery. 

3. Development. — To be robust the newly-born 
infant must have a certain average length and 
weight. The length varies between sixteen and 
twenty-two inches, and the weight between six and 
eight pounds. 

From the first day, growth or increase in length 
and weight, steadily progresses, according to cer- 
tain definitely fixed rules. 

Length increases most rapidly during the first 
week of life ; afterward the progress is almost uni- 
form up to the fifth month, and then it becomes less 



?4 



HYGIENE OF THE NURSERY. 



rapid, though still uniform, until the end of the 
twelfth month. 

These facts may be seen in the following table : — 



AGE. 


LENGTH. 


Birth. 


19.5 inches. 


I month 


20.5 " 


2 " 


21. " 


3 il 


22. " 


4 " 


23. 


5 " 


23.5 " 


6 « 


24. 


7 " 


24.5 " 


8 « 


25. « 


9 " 


255 " 


IO " 


26. 


n " 


26.5 « 


12 " 


27. 



During the second year the increase is from three 
to five inches ; in the third from two to three and 
a half inches ; in the fourth from two to three 
inches, and from this age up to the sixteenth year 
the average annual gain is from one and two-thirds 
to two inches. 

In the first three days of life there is always a 



THE FEATURES OF HEALTH. 



25 



loss of weight, but by the seventh day the babe 
should have regained weight and be as heavy as at 
birth. The period of most rapid gain in this 
respect is during the first five months of life. The 
maximum is attained during the second month, 
when the increase is from four to seven ounces 
each week. Throughout the next three months 
the increase amounts to about five ounces per week, 
and in the remaining months of the first year, from 
two to five ounces. 

The subjoined table shows the average rate of 
gain :— 



AGE 


WEIGHT. 


Birth. 


7 pounds. 


1 month 


IK " 


2 " 


9 l A " 


3 " 


II " 


4 " 


12^ " 


5 " 


14 " 


6 " 


15 « 


7 " 


16 " 


8 " 


17 " 


9 " 


18 " 


10 " 


19 " 


11 " 


20 « 


12 " 


21 " 



26 HYGIENE OF THE NURSERY. 

From the first to the tenth year there should be 
a yearly gain of at least four or five pounds, and 
after, to the sixteenth year, of about eight pounds 
in the same period. 

Parents frequently over-estimate the weight of 
their children by placing them upon the scales 
when completely dressed. To be accurate, the 
weight of the clothing must be subtracted. This 
may be estimated at about three pounds for a child 
of three to five years, four pounds for one of eight 
years, and eight pounds at fifteen years. 

Another reliable evidence of the proper progress 
of development is the increase in the girth of the 
chest. Taking an infant weighing seven pounds 
and measuring nineteen and a half inches at birth, 
this should be a little over thirteen inches. By the 
fourth month it should be increased to fifteen 
inches ; by the sixth, to sixteen ; by the twelfth, to 
about seventeen ; by the fifth year to twenty-one, 
and by the sixteenth year to thirty. 

As already mentioned, the proportions of the 
different members of the frame in infancy differ 
materially from those of adolescence. 

Primarily the head and secondarily the body are 
large when compared with the arms and legs, but 
in the progress of healthy development this dis- 
proportion is gradually lessened until the perfect 
human figure is attained. This developmental 



THE FEATURES OF HEALTH. 



27 



process, however, does not affect all parts of the 
body equally, as may be seen in the accompanying 
diagram.* (Fig. 2.) 

The description is so well put in the journal from 
which this figure is taken that I cannot do better 
than quote it word for word. 



Fig. 2. 




mm mm 
DIAGRAM SHOWING RELATIVE STATURE FROM I TO 22 YEARS OF AGE. 



" The six figures represent the average relative 
stature of males of the ages of one, five, nine, thir- 
teen, seventeen, and twenty- two years. It will be no - 
ticed that the figures all stand on a level plain. The 
tops of the heads are connected by a dotted line, and 



* " Babyhood," Vol. it, page 311. Paper by Leroy M. Yale, M.D. 



2S HYGIENE OF THE NURSERY. 

the height of each figure is divided into four equal 
parts, the points of division being connected with 
the corresponding ones in each figure. If the rate 
of growth were uniform the dotted lines connect- 
ing the heads would, of course, be straight if a 
child for every year were included in the rank. 
But in the earlier years the growth is much more 
rapid than it is later, and hence the line is a curve, 
rising quite suddenly at the first, and becoming 
flatter toward the end of growth. It is to be 
understood that these are all averages — including, 
but not showing, the extremes of slowness and 
rapidity of growth as well as fitfulness of growth. 
The diagram also shows the different development 
of different parts of the person. The head, for 
instance, in the child of one year is nearly one- 
fourth of the whole height; that of the adult is about 
two-thirteenths, or, to use the phrase of artists, 
the little child is not much more than four heads 
high, while the adult of twenty-two is about six 
and one-half heads high ; and even this is a much 
larger head than the average adult has. Notice 
that the third dotted line, marking one-half of the 
total height, crosses the navel in the infant, while 
in the adult the half height mark is but little above 
the juncture of the legs and the body, which shows 
how much larger, proportionately, the body of an 
infant is than an adult's. If this same line be fol- 



THE FEATURES OF HEALTH. 29 

lowed it will be noticed that it keeps well up in the 
abdomen until after the age of nine. Between that 
age and puberty the growth of the lower extremi- 
ties is usually very rapid, and the well-known 
1 shooting up ' of boys and girls takes place, the 
whole person growing, but the lower part in par- 
ticular. Similar changes of location will be noticed 
by following the quarter-lines, but the changes are 
not so abrupt." 

It may be well to mention here that children 
will often remain, for a considerable time, almost 
stationary in height, and then have periods of very 
rapid growth. The latter is often to be observed 
in the ninth or tenth year, and again at the 
approach of puberty. Variations in weight-gain 
are also often to be observed ; these seem to hold 
a definite relation to the fluctuations in the rapidity 
of height-increase. 

Besides these points, which are the most reliable 
evidences of the proper progress of development, 
there are certain features that appeal more directly 
to the notice of parents, and on this account deserve 
consideration. The age at which a child sits erect, 
at which it creeps, walks or talks, are instances of 
the class of features referred to. 

The head can usually be held erect by the end 
of the third month and the body maintained in the 
sitting posture a month later. By the sixth month 



30 HYGIENE OF THE NURSERY. 

the infant can sit up with ease, accomplish many 
movements with the arms, hands and fingers, and 
enjoy playthings. At the eighth month he may be 
able to creep ; by the ninth or tenth, to drag him- 
self upon his feet with the assistance of his hands 
and arms and some artificial support ; by the elev- 
enth, to walk with assistance ; by the fourteenth, to 
walk alone, and by the eighteenth, to run. 

At eight months an infant will imitate sounds 
and articulate several syllables ; at ten, can often 
speak one or two words, and after twelve months 
is able to join several w r ords together. 

The anterior fontanelle should be completely 
closed at some period between the fifteenth and 
twentieth months. 

Tears begin to be secreted during the third or 
fourth month, and saliva, between the fifth and sixth. 

After birth both hair and eyes often change color 
as age advances. When an alteration takes place 
in the eyes, it begins about the sixth or eighth 
week and may be to either a lighter or darker hue. 
Changes in the hair begin later, the tendency always 
being to darken, and the most marked alteration 
occurring between the seventh and fourteenth years. 

Examples of Variations in Disease. — If on being 
measured and weighed, a child be found to fall 
short of the normal standard for its age, and if, at 
the same time, there is a want of plumpness of 



THE FEATURES OF HEALTH. 3 1 

body, roundness of limb, and firmness of flesh, the 
existence of some fault in diet or in the digestion 
and absorption of food must be inferred. 

A delay in walking may be due to general feeble- 
ness or to paralysis of the muscles of one or both 
legs, and a limping gait with pain in the knee 
suggests hip-joint disease. 

Closure of the fontanelle is retarded by the 
disease called rickets, and also by hydrocephalus 
and constitutional syphilis. 

It is well to be cognizant of the fact that girls 
develop more rapidly than boys, and that the second 
or later children of the same family, by imitating 
their elders in the nursery, learn to talk and walk 
earlier than those who are born first. 

4. Position and Gestures. — The complete re- 
pose depicted on the countenance of a sleeping 
child when free from illness is shown also by the 
posture of the body. The head lies easy on the 
pillow, the trunk rests on the side, slightly inclined 
backward, the limbs assume various but always 
most graceful attitudes, and no movement is 
observable but the gentle rise and fall of the 
abdomen in respiration. In the waking state, the 
child, after early infancy, is rarely still. The move- 
ments of the arms, at first awkward, soon become 
full of purpose as he reaches to handle and examine 
various objects about him. The legs are idle 



32 HYGIENE OF THE NURSERY. 

longer, though these, too, soon begin to move about 
with method, feeling the ground, in preparation, as 
it were, for creeping and walking. 

Examples of Variations in Disease. — Restless sleep 
with a desire to be rocked, fondled or u walked" in 
the nurse's arms, are common symptoms of acute 
attacks of illness, especially when attended by 
pain. Children beyond the age of infancy toss 
about uneasily in bed or demand a change from 
the bed to the lap, under similar circumstances. 
Extreme and long-continued drowsiness and quiet- 
ness, on the other hand, often precede the 
onset of such specific fevers as scarlatina or 
measles. 

Sleeping with the head thrown back and the 
mouth open indicates enlarged tonsils ; a tendency 
to " sleep high," or with the head and shoulders 
elevated by the pillow, accompanies disease of the 
heart and lungs, and " sleeping cool," that is, resting 
only after the bed clothing has been kicked off, is 
an early symptom of rickets. 

Frequent carrying of the hand to the head, ear 
or mouth shows headache, earache, or the pain of 
a coming tooth, as the case may be, while constant 
rubbing of the nose is a feature of irritation of the 
bowels or stomach. 

Should the thumbs be drawn into the palms of 
the hands, and the fingers tightly clasped over 



THE FEATURES OF HEALTH. 33 

them, or if the toes be strongly flexed or extended, 
a convulsion may be expected. 

5. The Voice. — Crying is the chief if not the 
only method that the young infant possesses of 
making known his displeasure, discomfort or suffer- 
ing, and affords almost the sole means of determin- 
ing the characters of the voice at this early age. 
Again, even long after the powers of speech have 
been developed, the cry continues to be the main 
channel of complaint. 

One rarely hears a healthy child cry, unless a 
harsh word, a fall or a blow cause a passing storm 
of grief, anger or pain. Hence, frequent, peevish 
crying points to some disturbance of the healthy 
balance. 

The sound of the voice, whether in crying or 
speaking, should have a clear ring, without either 
muffling, hoarseness or nasal tone. Weeping 
should accompany crying, after the establishment 
of tear secretion. Cough, although not a normal 
vocal sound, is also worthy of attention. 

Examples of Variations i?i Disease. — Incessant, 
unappeasable crying is usually due to earache or 
hunger ; it frequently, too, is caused by the constant 
pricking of a badly-adjusted safety-pin or other 
mechanical irritant. 

If crying occur during an attack of coughing it 
is an indication of some painful affection of the 
3 



34 HYGIENE OF THE NURSERY. 

chest; if just before or after an evacuation of the 
bowels, of intestinal pain. 

When the cry has a nasal tone it should suggest 
swelling of the lining membrane of the nose, or 
other obstructing condition. Thickening and indis- 
tinctness occur with throat affections. A loud, 
brazen cry is a precursor of spasmodic croup, and 
a faint, whispering cry of true or membranous 
croup. Hoarseness points to disease of the lining 
membrane of the larynx, either catarrhal or syphi- 
litic in nature. 

Finally, a manifest unwillingness to cry can be 
seen in pneumonia and pleurisy, when the dis- 
ease is severe enough to interfere materially with 
breathing. 

Tear-secretion having been established, it is a 
bad omen if the secretion be arrested during the 
progress of an illness, but an equally good one if 
there be no suppression, or if there be a reestab- 
lishment after suppression. 

The cough, like the voice, may be brazen in 
spasmodic croup, hoarse in laryngeal catarrh, and 
suppressed in true croup. The qualities "tight- 
ness " and " looseness " are readily appreciated and 
give a good idea of the progress of lung affections, 
especially bronchitis, the former being an evidence 
of the beginning, the latter of the favorable termina- 
tion of an attack. 



THE FEATURES OF HEALTH. 35 

Cough is always unproductive, that is, unattended 
by expectoration, in children under seven years of 
age. 

6. Mode of Drinking and Swallowing. — By 
watching an infant taking the breast or bottle, 
some information can be obtained of the condition 
of the mouth and throat, and of the respiratory 
organs. 

A healthy child drinks continuously without 
stopping to breathe, and swallows easily. 

Examples of Variations in Disease. — If there be 
any soreness of the mouth the nipple will be held 
only for a moment and then dropped with a cry of 
pain. When the throat is affected in infants, swal- 
lowing is performed with a gulp and an expression 
of pain passes over the face, and no more efforts 
are made than required to satisfy the first cravings 
of hunger. Older children, under similar circum- 
stances, drink little and refuse solid food. 

An infant suffering from the oppressed breathing 
of pneumonia or severe bronchitis, seizes the nipple 
with avidity, swallows quickly several times and 
then pauses for breath. In older children the act 
of drinking, which should be continuous, is inter- 
rupted in the same way. 

If the finger be put into the mouth of a healthy 
baby it will be vigorously sucked for some little 
time. Diminution of this act of suction during a 



36 HYGIENE OF THE NURSERY. 

severe illness is a sign of danger ; its reestablish- 
ment a good omen. In conditions of stupor it is 
noticeably absent. 

7. Appetite. — Hunger and appetite must not be 
regarded as synonymous terms. The former is the 
craving of all the tissues of the body for nutritive 
material, or food, and is expressed by a sinking or 
craving sensation in the stomach. The latter, on 
the other hand, though it is certainly an attendant 
of hunger, is simply a sensation of the desire for 
something with a food-taste, having its seat in the 
mouth and surrounding parts. Appetite having its 
post, as it were, at the entrance of the stomach, 
may be regarded as a gate-keeper to supervise 
everything presented for entrance and to reject all 
that may be injurious either to the stomach or the 
general economy. 

Like its analogue the gate-keeper, the trust- 
worthiness of the appetite may be destroyed by 
over-indulgence and bad habits. Under the last 
head come the constant administration of too much 
or too little food, the use of over-rich food and 
irregularity in meal hours. 

A healthy appetite — that is one that leads a child 
to consume with enjoyment the food set before 
him — may be encouraged by muscular and mental 
exercise; by contentment; by regular habits as to 
the hours of eating; by the use of plain food only, 



THE FEATURES OF HEALTH. 37 

and by varying the food, in a greater or less degree, 
according to the age. If the quantity of food con- 
sumed at the regular meals does not come up to 
the parent's standard of sufficiency, it does nothing 
but harm to resort to too dainty feeding and to an 
encouragement to eat between meals. 

There can be no question that a good appetite is 
a useful as well as a pleasant faculty for a child to 
possess, for there is no doubt that food eaten with 
relish is much better digested and therefore more 
serviceable in nutrition than that which is simply 
crowded into the stomach. 

Examples of Variations in Disease. — Loss of appe- 
tite is encountered in febrile attacks and in acute 
disorders of the stomach. Inordinate appetite, on 
the contrary, is usually met with when too strong 
food has been administered. Here the increased 
hunger is due to the fact that the food administered, 
while it may be very rich in nutritive properties, is 
ill-adapted to the delicate digestive power of early 
life, and thus, by not being properly prepared for 
absorption, places the child in the anomalous po- 
sition of starving in the midst of plenty. In more 
advanced children gluttony may depend upon gas- 
tric irritation, a condition which often leads older 
and presumably wiser heads to over-indulgence at 
table. 

8. Eructation. — Eructation or regurgitation is 



38 HYGIENE OF THE NURSERY. 

readily produced and of frequent occurrence in 
infancy, on account of the vertical position and 
more cylindrical outline of the stomach at this 
period of life. 

Babies suckled at a freely-secreting breast often 
eructate, though they may be in the best possible 
health. In these cases, the supply of food being 
large, the infant, as it lies at the breast, is apt to 
draw more than it needs and more than it can 
digest, and the stomach, through a wise provision 
of nature, rids itself of the superabundance by the 
simple act of regurgitation. In this process, which 
in reality is an evidence of health, there is no vio- 
lent muscular effort, as in retching or vomiting, nor 
any evidence of nausea, and the material ejected is 
the breast milk alone, either entirely unaltered or 
slightly curdled. 

In older children, expulsion of the contents of 
the stomach, or vomiting, may also occur after the 
stomach has been overladen. If the act be followed 
by relief from a feeling of general distress, head- 
ache and pain in the upper abdomen, it is not to be 
regarded as a symptom of disease. 

Examples of Variations m in Disease. — Vomiting, 
with its violent muscular effort and the attendance 
of the train of symptoms embraced under the term 
nausea — namely, paleness, languor, faintness and 
an increased secretion of saliva — occurs in many 



THE FEATURES OF HEALTH, 39 

different conditions. It may indicate disease of the 
stomach, of the intestines, of the lungs or their 
pleural investment, and of the brain ; or it may be 
an initial symptom of one of the eruptive fevers, 
scarlet fever or measles, for example, which con- 
dition, when existent, can only be determined by 
closely observing the special case. 

The character of the material ejected from the 
stomach is more definite. Thus, the expulsion of 
mucus is a symptom of gastric catarrh. The 
regurgitation of mouthfuls of curdled milk, partly 
digested food and liquid, so sour that it causes a 
grimace to pass over the face, is an indication of 
dyspepsia with fermentation and the formation of an 
irritant acid. The appearance of lumbricoid worms 
in the vomit, a not very infrequent occurrence, 
shows, without dispute, the existence of these para- 
sites in the digestive canal. 

9. The Faecal Evacuations. — The daily num- 
ber of evacuations of the bowels natural for a child 
varies greatly with its age. For the first six weeks 
there should be three or four movements every 
twenty-four hours. After this time up to the end 
of the second year, two movements a day is the 
normal average. Subsequently, the frequency is 
the same as in adults — once per diem — though two 
or three movements in the same interval may occur, 
especially after over-feeding or after eating food 



4-0 HYGIENE OF THE NURSERY. 

difficult of digestion, and must be looked upon as 
conservative rather than as the evidence of ill-health. 

During the first period the passages have the 
consistence of thick soup, are yellowish-white or 
orange-yellow in color, with sometimes a tinge of 
green; have a faint faecal, slightly sour odor, and 
are acid in reaction. In the second, they are 
mushy or imperfectly formed, of uniform consistence 
throughout, brownish-yellow in color, and have a 
more faecal odor. The last two characters become 
more marked as additions are made to the diet. 
After the completion of the first dentition the 
motions have the same appearance as in adult life ; 
they are formed, are brownish in color, and have a 
decided faecal odor. 

Examples of Variations in Disease. — Many altera- 
tions occur in disease. The frequency of the 
movements may be increased, constituting diar- 
rhoea, or lessened, constituting constipation. In 
the former condition the consistency is diminished, 
in the latter, increased. Instead of being uniform 
throughout, the movement may be mixed, partly 
liquid, partly solid, indicating imperfect digestion, 
and curds of milk or pieces of undigested solid food 
may be mingled with the mass. Flaky, yellowish 
or yellowish-green evacuations, containing whitish, 
cheesy lumps, are also met with in cases of indiges- 
tion. Scanty, lumpy evacuations, dark brown or 



THE FEATURES OF HEALTH. 4 1 

even black in color, and mixed with mucus, are 
characteristic of intestinal catarrh. Doughy, gray- 
ish, or clay-colored motions show an inactive liver. 
An intermixture of blood, altered blood clots, and 
shreds of mucous membrane, indicate ulceration of 
the intestinal lining, such as occurs in intestinal 
inflammation, typhoid fever, dysentery and tuber- 
cular disease. Watery, almost odorless passages 
occur in the latter stages of summer complaint ; 
most offensive, carrion-like motions, in both catar- 
rhal and tuberculous ulceration of the intestines, 
and sour-smelling evacuations in the diarrhoea of 
sucklings. The discovery of worms in the move- 
ments is the only certain evidence of the existence 
of intestinal parasites. 

This mere outline of the changes that may take 
place will serve to show how much may be learned 
from the evacuations, and the importance of pre- 
serving them for the physician's inspection. 

10. The Urine. — It is impossible to make a 
definite statement as to the number of times the 
urine is voided by a healthy infant in each twenty- 
four hours. In any given case the frequency will 
differ very much from day to day, depending upon 
the temperature of the surrounding air and the 
amount of moisure that it contains. Sometimes 
it will be necessary to change the napkin every 
hour during the day and three or four times at 



42 HYGIENE OF THE NURSERY. 

night. Again, it may remain dry for six, eight, or 
even ten hours. Neither condition indicates dis- 
ease. If, however, the urine is not passed for twelve 
hours, a careful examination should be made. 

Between these two extremes there is a wide range 
of variation. 

As the child grows older the frequency dimin- 
ishes, and at the age of three years the number of 
voidings will be reduced to six or eight during the 
waking hours, and perhaps one at night. When 
the desire dees arise during sleep, the child, if in a 
normal state, wakes up and demands the chamber, 
and never passes urine unconsciously. Wetting 
the bed, therefore, or the involuntary passage of 
the urine during sleep, is indicative of an abnormal 
condition and requires investigation. From a few 
observations, I am led to believe that the quantity 
of urine voided by healthy children from the 
fourth to the seventh years is not nearly so large 
as supposed ; eighteen to twenty ounces being the 
average in several cases in which I have lately 
made measurements. 

The urine of an infant, while it wets, should not 
stain the napkin. 

Examples of Variations in Disease. — In certain 
cases of bad digestion the urine becomes very con- 
centrated and high-colored, and gives a light yellow 
tinge to the napkin. When the stain is decidedly 



THE FEATURES OF HEALTH. 43 

yellow, jaundice is indicated, and other symptoms 
of this condition should be looked for. 

In older children a high-colored urine, and one 
which deposits a whitish or purplish sediment on 
standing, is symptomatic of acute digestive dis- 
order, either catarrhal in its nature, or secondary 
to some acute febrile affection. A smoky, blackish 
hue, looking as if there had been an admixture of 
soot, is characteristic of the acute kidney disease 
that often follows in the wake of scarlet fever; in 
this state, too, there is a great diminution in the 
amount passed, 

Painful urination points to inflammation of the 
urethra, a narrow orifice, a highly acid condition of 
the excretion, or stone in the bladder. 

11. The Respiration. — In adults there are twe 
well-marked types of respiration, viz., the abdominal 
and the superior costal. The abdominal — met with 
in perfection in adult males — is the type in which 
the movements of inspiration and expiration are 
performed by the muscles of the abdomen and 
lower third of the chest. In superior costal respi- 
ration, on the other hand, the movements are most 
marked in the upper third of the chest; this form 
is best developed in healthy adult females. 

In children the respiration is chiefly abdominal 
in type, irrespective of sex, and it is not until just 
before the age of puberty that the movements in 



44 HYGIENE OF THE NURSERY. 

the female change, becoming superior costal. Con- 
sequently, in estimating the number of movements 
per minute it is best to place the fingers lightly on 
the upper abdomen. The count should always be 
made by the watch, the most convenient time for 
the observation being while the child sleeps. 

Soon after birth the number of movements per 
minute is 44, between the ages of two months and 
two years, 35, and between two and twelve years, 
23. During sleep the frequency is reduced about 
twenty per cent. 

Children under two years, while awake, breathe 
unevenly and irregularly; there are frequent pauses 
followed by hurry and precipitation, and some of 
the movements are shallow, others deep. In sleep 
there is greater regularity. After the second year 
the movements become steady and even, like those 
of adults. All children, however, but particularly 
the very young, are subject to a great increase in 
the rapidity of respiration under the excitement of 
muscular movement and mental emotion. 

Perfectly healthy children breathe through the 
nose, and so softly that it is necessary to place the 
ear close to the face to hear the breezy sound of 
the ingoing and outgoing air. 

Examples of Variations in Disease. — Accelerated 
breathing occurs during the course of diseases 
attended by severe fever. Acute affections of the 



THE FEATURES OF HEALTH. 45 

lungs are especially characterized by this alteration, 
and the more the breathing area is lessened the 
greater is the increase. Thus, in pneumonia, 60, 
80 or 100 movements a minute are not at all 
unusual. To speak broadly, rapid breathing may 
be caused by an elevation in the body temperature, 
by an interference with the blood aeration and by 
thoracic or abdominal pain. 

Diminished frequency — the movements being 
reduced to 16, 12, or even 8 in the minute — is 
encountered in certain brain affections ; namely, in 
chronic hydrocephalus, and the later stages of 
tubercular meningitis. In such cases the rhythm 
may be greatly altered — a tidal form being 
assumed, in which the breathing ebbs and flows, 
beginning with an act v/hich is scarcely perceptible 
or audible, gradually growing deeper until a full, 
noisy respiration is made, and then slowly subsiding 
into a period of absolute quiet, variable in its dura- 
tion. This is termed Cheyne-Stokes' respiration. 

A dry, hissing sound, or a moist sound of 
snuffling indicates partial obstruction of the nasal 
passages ; oral respiration shows their complete 
occlusion. 

Yawning, one of the modifications of the res- 
piratory act, if it recur frequently, denotes great 
failure of the vital powers and is an unfavorable 
prognostic element. 



4 6 



HYGIENE OF THE NURSERY 



12. The Pulse. — To obtain any reliable data 
from the pulse it must be felt during perfect quiet 
During sleep is the best time, but if the child cam 
not be caught in this condition, advantage may be 
taken of its placidity while feeding or amused by a 
toy. With very young infants it is sometimes 
impossible to feel the beat of the artery at the 
wrist, and it is necessary to ascertain the frequency 
of the pulse by listening to the heart. After the 
second month feeling the pulse at the wrist in the 
ordinary way is not difficult. 

The child's pulse differs from the adult's by 
being much more frequent, more irregular, and 
more irritable. 

The frequency, or the number of beats per 
minute, varies with the age. The following is the 
average rate : — 



From birth, to the 2d month, 
From the 2d to the 6th month, 



" 6th 


ii 


1 2th '• 


" ISt 


14 


3 d )" ear > 


" 3d 


II 


5th " 


" 5th 


«( 


ioth " 


" loth 


U 


1 2th " 



i6o to 130 
130 to 120 
120 to no 
no to 100 
100 to 90 
90 to 8o 
So to 70 



These figures represent the pulse in a waking, 
but passive state. During sleep the frequency is 
less. Thus, between the second and ninth years, 
there are about sixteen beats less per minute while 
asleep than when awake ; between the ninth and 



THE FEATURES OF HEALTH. 4/ 

twelfth years, eight less ; and between the twelfth 
and fifteenth years, only two less. Below the age 
of two years the disparity is even greater. 

The irregularity of the pulse in childhood is 
confined to an alteration of the rhythm, in other 
words, of the intervals at which the beats succeed 
each other and the relative strength and volume of 
each beat. It is most marked in infants and is 
greatest during sleep, when the pulse is slowest. 

The feature of irritability, that is, the facility 
with which the frequency is increased by muscular 
activity and mental excitement, is greater in pro- 
portion to the youth of the child. A rise of 20, 30, 
or even 40 beats a minute is not uncommon in 
early infancy, under the excitement of the slightest 
effort or disturbance. 

Examples of Variations in Disease. — On account 
of the wide variations in health, little meaning 
need be attached to alterations of the rhythm and 
frequency while unassociated with other abnormal 
features. When so associated they become impor- 
tant in determining the existence of disease. 

Increased frequency is a constant attendant of the 
febrile state. The extent of the increase corre- 
sponds with the degree of elevation of temperature, 
though the pulse curve always runs higher than the 
temperature curve. As a rule, the more frequent 
the pulse the higher the fever. In estimating the 



4$ HYGIENE OF THE NURSERY. 

risk of the increase, however, the law of the fever 
in question must be taken into consideration. For 
example, in scarlet fever a pulse of 160 is usual 
and not indicative of especial gravity. In measles, 
the same degree of acceleration would be abnormal 
and show great danger. 

Jaundice and inflammation of the kidneys are 
accompanied by a diminution of the pulse rate. 

Irregularity is met with in diseases of the brain 
and heart, and sometimes in nervous and blood- 
impoverished children. 

13. The Temperature. — By placing the hand 
upon the surface of the body we can readily detect 
marked variations in the temperature; thus the 
nose and extremities feel cold in diseases associ- 
ated with depression of the vital forces, and the 
palms of the hands and back of the head feel hot 
in those attended by fever. But the only possible 
means of detecting slight variations or of obtain- 
ing reliable information concerning normal or 
abnormal body-heat is by the employment of an 
accurate thermometer. Clinical thermometers, as 
these instruments are called, are made entirely of 
glass, and are usually furnished in the shapes seen 
in Figs. 3 and 4, p. 49. 

Both of these instruments are graduated accord- 
ing to the Fahrenheit scale and provided with a 
self-registering index, which is simply a short 



THE FEATURES OF HEALTH. 



49 



column of mercury separated from that in the bulb 
of the thermometer. 



Fig. 3. 



Bulb with / 
Mercury. N 



UL 




.98.5° normal mark. 

Index, read from top, 
stands now at 98 . 



98. 5 normal mark. 



Index, read from top, 
stands now at 98.5 . 



CURVED THERMOMETER. 



STRAIGHT THERMOMETER. 



Temperature is usually taken in the rectum of 
4 



50 HYGIENE OF THE NURSERY. 

the infant or young child, in the arm-pit of one old 
enough to understand the importance of keeping 
the arm in the proper position, and in the mouth 
of a child still older. In the first locality a straight 
thermometer is the best to use, in the last two a 
curved instrument will be found more convenient. 

Supposing the rectum be chosen as the place of 
observation, it is first necessary to be sure that 
this portion of the gut is free from faeces. The 
upper end of the stem of the thermometer is then 
held between the thumb and finger, and the index, 
by a few vigorous shaking movements, is forced 
down so far that its upper extremity will be well 
below the normal mark, to 95 ° for instance; next, 
the bulb is covered with sweet oil or vaseline and 
gently inserted through the anus into the rectum 
for a sufficient distance to conceal completely the 
mercury. Here it is allowed to remain for five 
minutes by the watch, and on being removed the 
degree of temperature is read from the top of the 
index. The position of the patient in the meanwhile 
is upon the back, on the nurse's lap, with the legs 
elevated and controlled by her left hand, the right 
hand being used in steadying the thermometer. 

If the arm-pit be selected, place the child on his 
back, and dry this region of all moisture ; next 
shake down the index and insert the bulb well into 
the cavity ; lay the arm across the chest, place the 



THE FEATURES OF HEALTH. 5 I 

hand on the opposite shoulder and hold in this 
position for five minutes. 

When taking the temperature in the mouth direct 
the child to lie down on his back and instruct him 
not to bite upon the delicate glass. Then, having 
seen that the instrument is thoroughly clean and 
that the top of the index is below the normal point, 
insert the bulb, crosswise, beneath the tongue. The 
teeth must be lightly closed so as to hold it in 
position, and the lips closely shut about its stem. 
For the three minutes necessary to complete the 
observation, breathing must be performed entirely 
through the nose. 

One more fact is important, namely, that a simul- 
taneous observation in the three positions men- 
tioned will not furnish identical results ; the rectal 
temperature being, normally, from i° to 2° higher, 
and the oral at least i° higher, than that of the 
arm-pit in the same individual. 

When properly used the thermometer is of great 
value in the nursery ; at the same time, under oppo- 
site conditions, it maybe the source of much unne- 
cessary alarm- to over-anxious parents. To prevent 
the latter misfortune, all who intend to use the in- 
strument should be familiar with the healthy range 
of temperature and some of the characteristic varia- 
tions in disease. 

During the first week of healthy life the temper- 



52 HYGIENE OF THE NURSERY. 

ature fluctuates considerably. After this the pue- 
rile norme — 98. 5 ° to 99 F. — is established, but 
until the fourth or fifth month it is greatly influ- 
enced by physiological causes of variation, the 
fluctuations ranging between .9° and 3.6 . By the 
fifth month regular morning and evening oscilla- 
tions begin to be noticeable, and certain definite 
laws are followed. Thus there is a fall in the even- 
ing of i° or 2°. The greatest fall occurs between 
7 and 9 p.m., and the minimum is reached at, or 
before, 2 a.m. After 2 a.m. there is a gradual rise, 
the maximum being reached between 8 and 10 a.m. 
Throughout the day the oscillation is trifling. 
These variations are independent of eating and 
sleeping. 

It may be taken for granted, therefore, that a 
temperature between 98 and 99 in the morning 
and 97. 5° and 98.5 ° in the evening is the range to 
be expected in a healthy child beyond the age of 
five months. 

Examples of Variations in Disease. — In disease 
there may be either a rise above or a fall below the 
normal standard. 

Fever is always associated with an elevation. 
Rapid and transient rises attend slight catarrhs 
and passing indigestions. Prolonged rises indicate 
inflammatory and essential fevers, for example, 
typhoid, scarlet fever and measles. 



THE FEATURES OF HEALTH. 53 

The degree of elevation marks the type of the 
fever. This is moderate when the mercury stands 
at 102 , severe at 104 or 105 °, and very grave 
above 107 . The duration of the elevation and the 
peculiar range of the oscillations (for there are oscil- 
lations in disease as well as in health) determine the 
nature of the fever. The febrile oscillations differ 
from the healthy, in that the lowest marking is 
noticed in the morning, the highest in the evening. 

Variations in the typical range of any given fever 
are important prognostic omens — a sudden fall of 
the temperature, together with improvement in 
the general symptoms, indicates the beginning of 
convalescence — a similar fall, with an increase of 
the general symptoms, is a precursor of death. 
When the morning temperature is equal to that of 
the preceding evening, there is great danger; if 
higher, greater danger still. Marked remission in 
continued fevers is generally a forerunner of con- 
valescence. 

Abnormal depression of temperature is occasioned 
by hemorrhage and by the loss of fluids in cholera 
infantum or entero-colitis. It is also met with in 
anaemia, in wasting from insufficient nourishment, 
in diseases of the heart and lungs attended by im- 
perfect oxidation of the blood, and it constantly 
attends collapse and the death agony. A tempera- 
ture of 97 is dangerous in children, and for every 



54 HYGIENE OF THE NURSERY. 

degree of reduction below this point the risk for life 
is more than proportionately increased. 

14. The Mouth and Throat. — In infants, gentle 
pressure of the fingers upon the chin is sufficient to 
cause wide opening of the mouth. An older child 
will frequently open the mouth when requested, 
but if he refuses, the finger, or, far better, the handle 
of a spoon, or some other smooth, flat instrument, 
may be inserted in the mouth, and downward pres- 
sure made upon the tongue, when the jaws will be 
widely separated. In some cases, when the child 
is old enough to do as he is bid, the fauces can be 
seen by directing the mouth to be opened wide and 
the tongue to be alternately protruded and retracted, 
or a prolonged sound of " Alt " to be made. With 
the refractory, and always with infants, the tongue 
has to be held down by a spoon-handle or tongue- 
depressor. If there be resistance, the patient must 
be taken on the lap of the nurse, who holds his 
back against her breast, directs his face toward a 
bright light, and controls the movements of his 
hands and feet. 

The healthy oral mucous membrane has a deep 
pink color, and is smooth, moist and warm to the 
touch. The color is deeper on the lips and cheeks, 
lighter on the gums. The latter, up to the sixth 
month, as a rule, have a moderately sharp edge. 
Subsequently, the edge begins to broaden and 



THE FEATURES OF HEALTH. 55 

soften, and the color of the investing mucous mem- 
brane deepens to a vivid red, and becomes hot, as 
the teeth begin to force their way through. 

The tongue should be freely movable. It is pink 
in color, and the dorsum or upper surface, marked 
in the centre by a sligty; longitudinal depression, 
has a velvety appearance, and is soft, moist and 
warm to the finger. The velvety nap is due to the 
numberless hair-like processes of the filiform papil- 
lae. There are also scattered over the surface, but 
most clearly at the tip, a number of eminences, the 
size of a small pin's head, circular in outline, and 
deeper pink than the general surface — the fungi- 
form papillae. While far back, defining the papil- 
lary layer, are the circumvallate papillae, numbering 
about twelve, and arranged in a V-shaped row. 
These have the form of an inverted cone, sur- 
rounded by an angular elevation. 

The hard palate, or roof of the mouth, is roughened 
anteriorly by transverse ridges. The soft palate — 
its continuation — is smooth, and its mucous mem- 
brane is paler than that of the rest of the mouth. 
The fauces, or walls of the throat, on the contrary, 
are redder. In the triangular recess between the 
half arches of the palate the tonsils can always be 
seen. They should be about the size and shape of 
almond kernels, and they present a number of cir- 
cular openings, the orifices of pouches, into which 



56 HYGIENE OF THE NURSERY. 

the follicles open. The uvula — or, in popular lan- 
guage, the palate — is short and tongue-shaped. 
The posterior wall of the throat should be red, 
smooth and moist. 

Examples of Variations in Disease. — Fever makes 
the mouth hot and dry, an^ causes the tongue to be 
frosted or coated. Affections of the stomach and 
bowels are usually attended by coating of the 
tongue. Inflammation of the mouth itself reddens 
the lining membrane, makes it hot and tender to 
the touch, increases its moisture, alters the surface 
of the tongue and leads to the formation of aphthae 
and to ulceration. 

15. Dentition. — The eruption of the twenty milk 
teeth may, like other physiological processes, be 
unattended by noticeable symptoms, but in many 
instances it is accomplished with difficulty, giving 
rise to disturbances which, on the one hand, may 
be so trifling as simply to annoy the infant, or, on 
the other, so serious as to endanger life. 

Normally, the teeth are cut in groups, each effort 
being succeeded by a pause or period of rest. The 
diagram and table on page 57 show the grouping, 
the date of eruption and the duration of the pauses, 
the numbers, 1 to 5, indicating the groups to 
which the individual teeth belong and their order 
of appearance, and the letters a and b the prece- 
dence of eruption in the different groups. 



THE FEATURES OF HEALTH. 



57 



The pauses are, to say the least, most helpful, 
giving the infant's system an opportunity to rest 
after each effort, to recover from any coincident ill- 
ness, and to prepare for the next strain. 

Even under normal conditions the edges of the 

Fig. 5. 




DIAGRAM SHOWING ERUPTION OF MILK TEETH. 

i i, Between the 4th and 7th months. Pause of 3 to 9 weeks. 2222, Between 
the 8th and 10th months. Pause of 6 to 12 weeks. 333333, Between the 
12th and 15th months. Pause until the 18th month. 4444, Between the 18th 
and 24th months. Pause of 2 to 3 months. 5555, Between the 20th and 
30th months. 



gums lose their sharpness and become swollen, 
rounded and reddened as the teeth approach the 
surface. At the same time the saliva is increased 
in quantity, and the mouth is unnaturally warm 



58 HYGIENE OF THE NURSERY. 

and the seat of abnormal sensations, evidenced by 
the tendency to bite upon any object that comes to 
hand ; in other words, there is a condition of mild 
catarrh of the mucous membrane. The consequent 
discomfort, though, is not sufficient to interfere with 
the child's appetite, good humor or sleep, and when, 
after a few days, the margin of the tooth is free, all 
the local symptoms vanish. 

Examples of Variations. — Abnormal dentition is 
manifested either by departures from the laws of 
development already stated, or by actual difficulty 
in the process of cutting. 

The standard rules for the eruption of the teeth 
may be departed from in three ways : — 

i . The appearance of the teeth may be premature. 
Children may be born with one or more of their 
teeth already cut ; these are usually imperfect, and 
soon fall out, to be replaced, at the proper age, by 
well-formed milk teeth. Sometimes, however, they 
remain permanently, as in a case that came under 
my own observation. Natal teeth are always 
incisors. Instances of the lower central incisors 
being cut in the third month are not uncommon. 
Girls are more apt than boys to cut their teeth 
early, and, as an early dentition is likely to be an 
easy one, the occurrence is to be looked upon as 
fortunate. 

2. Dentition may be delayed. This deviation is 



THE FEATURES OF HEALTH. 59 

more frequently seen and of more consequence than 
the first. Bottle-fed babies, as a class, are more 
tardy in cutting their teeth than those reared at the 
breast. With such, though healthy in every re- 
spect, a delay of one or two months is a common 
and not at all serious event. On the contrary, 
whatever the method of feeding, if no teeth have 
appeared by the end of a year, it may be assumed 
that the child's general nutrition is faulty, or that 
rachitis is present. Delay does not necessarily 
imply difficulty in cutting the teeth, though the 
two conditions are often associated. 

3. The teeth may appear out of their regular 
order. Bottle-fed infants are most likely to show 
this irregularity, which is of some importance as an 
indication of general feebleness. In other instances, 
however, it is merely a family peculiarity, and, as 
such, bears no special significance. 

Difficult dentition gives rise to two classes of 
affections, viz., local, and sympathetic or reflex. 
Difficulty, like delay, is more apt to occur in 
hand-fed babies than in those nourished entirely 
from the healthy breast, but beyond this it is impos- 
sible to prognosticate the ease or difficulty of den- 
tition. The author has frequently seen the most 
robust infants suffer at the time of eruption of each 
group of teeth, and has also observed puny and 



6<D HYGIENE OF THE NURSERY. 

feeble subjects pass through the process with little 
or no trouble. 

The third and fourth groups of teeth are most 
prone to make trouble, and when the child is born 
at such a time of the year as to bring the eruption 
of these during the hot months, illness of some sort 
may be anticipated. This is often dangerous and 
sometimes fatal ; hence the popular dread of the 
" second summer." 

The order of eruption of the permanent teeth is 
as follows : — 

The two central incisors of lower jaw, from the 6th to 8th year. 
" " " upper " " 7th to 8th 

four lateral " " 8th to 9th 

" first bicuspids, " 9th to 10th 

" canines, " iothtoilth 

" second bicuspids, .... " 12th to 13th 

These replace the temporary teeth ; those which 
are developed de novo appear thus: — 

The four first molars, from the 5th to 7th year. 
" " second molars, from the 12th to 13th year. 
" " third molars, from the 17th to 21st year. 

There are, therefore, twelve more permanent 
teeth, making thirty-two in all — sixteen in each 
jaw. 



THE FEATURES OF HEALTH. 6l 

The diagram, Fig. 6, will aid in explaining the 
process : — 




DIAGRAM SHOWING RELATION BETWEEN PERMANENT AND TEMPORARY TEETH. 

The figures i, 2, 3, etc., indicate the groups of teeth and the order of their 
appearance. 



Second dentition is a common cause of ill health 
in late childhood. The disorders produced by this 
process, however, are not so well defined nor so 
dangerous as those of primary dentition, and, in 
consequence, the relation of cause and effect is often 
overlooked. 

It is probable that the first and seventh sets are 
the most apt to give rise to both local and consti- 
tutional disturbances. 



62 HYGIENE OF THE NURSERY. 



CHAPTER II. 

THE NURSERY. 

Every well-regulated house in which there are 
children should be provided with two nurseries, one 
for occupation by day, the other by night. 

Before entering further into the subject, however, 
attention must be directed to the fact that the 
American city-bred child, belonging to the class in 
which it is possible to provide separate rooms for 
nurseries, is to a greater or less degree a migratory 
creature. For when the first warm days of May or 
early June make the parents bask at open windows, 
the child is hurried off to a suburban hotel or farm- 
house or to the sea-coast. Again, so soon as the 
cold evenings of late September suggest the com- 
fort of an open fire, equal energy is exhibited to 
get him back to cosy winter quarters. In summer, 
most of the waking hours are spent in the open 
air, in winter, the greater proportion indoors, hence 
the day nursery must be regarded as a winter 
resort, and as such must possess qualities that 
would render it uninhabitable by the child in hot 
weather. The night nursery should have, though 
to a much less degree, the same qualities. In 



THE NURSERY. 63 

other words, to put the whole subject in a nut-shell, 
the nurseries for winter use should be warm and 
freely exposed to the sun ; for summer use, cool 
and rather shaded, though always perfectly dry. 

Since the child spends so much time in the open 
air during warm weather, the nurseries will be dis- 
cussed in this chapter purely from their winter 
standpoint, and will be described under the fol- 
lowing heads : — 

Situation. — Any room in the house will not do 
for a day nursery. Rather, on the contrary, must 
the best room be selected. It should have a south- 
west exposure, and be, if possible, so situated in 
the building as to allow of at least two broad 
windows,* one in the southern end and one in the 
western side. Into such a room the sun plays with 
full force from a few hours after rising until nearly 
the time of setting. The third floor of a house is 
a better elevation for the nursery, especially if there 
be an attic above, than either of the lower floors, 
partly because such rooms are remote from the 
ordinary domestic disturbances, but chiefly because 
they are drier and more readily heated, and being 
elevated, are less cut off from sunlight by sur- 
rounding buildings. 

The night, should, if possible, adjoin and com- 

* Nursery windows must always be strongly barred. 



64 HYGIENE OF THE NURSERY. 

municate with the day nursery, though this feature 
is less important than proximity to the parents' 
sleeping-room. It should have a good-sized window 
so placed that it will freely admit sunlight during 
the day. When the nurseries connect, the opening 
of communication must be capable of being com- 
pletely closed by a well-fitting door or folding doors, 
so that one room may be thoroughly aired without 
chilling the other. 

Neither apartment ought to communicate with 
a bath-room having sewer connections ; in fact, 
although it may be an object of complaint from the 
nurse, the further off such a bath-room is the better 
for the health of the child. 

While it is a matter of difficulty to accomplish 
in an ordinary city house, it is, nevertheless, a 
necessary thing to have the nurseries in close prox- 
imity to, or even in communication with, the apart- 
ment in which' the parents sleep ; for then the nurse 
is forced to be morally purer and physically more 
attentive than if she have a section of the house to 
herself. 

Many mothers prefer to keep their children at 
night. Under this condition, the bedroom becomes 
the night nursery, and its situation must be as care- 
fully selected, and its hygiene as particularly guard- 
ed, as the regular night nursery; when, too, there 
are several children in the family, the risk of over- 



THE NURSERY. 65 

crowding in such apartments must be recognized 
and carefully guarded against. The factor of dis- 
turbed rest, by the different hours of retirement of 
children and parents, is, also, one of importance. 
On all of these accounts, a night nursery, under the 
control of a competent nurse, is, in my opinion, to 
be preferred. 

Size. — The amount of atmospheric air required 
by a healthy child to accomplish thorough oxidiza- 
tion of the blood in respiration is about the same 
as that demanded by adults. Therefore the small- 
est admissible room for either a day or night nur- 
sery for a single child must have a capacity of 
eight feet cube. For more than one child the rule 
ordinarily given is, to multiply this figure — eight 
feet cube — by the number of individuals. This 
rule works w r ell enough for a family of two or three 
children, but if the number be greater, the size of 
apartments required would much exceed any 
that could be found in ordinary houses. Lack of 
space, then, must be made up by more perfect 
methods of ventilation. To put the question in a 
more practical form, a room nine or ten feet high, 
twenty feet long and fifteen feet broad will readily 
accommodate, either for playing or sleeping pur- 
poses, two or three children, with one attendant, 
provided foul air be constantly removed and fresh 
air supplied by ventilation. 
5 



66 HYGIENE OF THE NURSERY. 

In every room the undermost stratum of air, and 
the one in which the child must pass the greater 
part of his time, whether awake or asleep, has a 
much lower temperature than the middle, and this, 
again, than the highest — the tendency of the heated 
air being always to rise to the top. Now, the 
greater the height of the apartment, the cooler will 
be the floor and its neighborhood ; consequently, a 
lofty ceiling — namely, one over ten, or, at most, 
twelve feet — while it makes an imposing show, is 
far from being desirable for a nursery, where ease 
of heating and the comfort and health of the occu- 
pants are the ends to be attained. On the other 
hand, a ceiling less than eight feet high will tend 
to make the room close, stuffy and over-warm, and 
correspondingly unhealthy. 

Lighting. — As already indicated, the only per- 
missible light for a day nursery is that derived from 
the sun, and the more plentiful this is, and the more 
directly it enters, the better. The night nursery 
may be illuminated by gas, by an oil lamp, by a 
candle or a night light. Writers ordinarily recom- 
mend the last three, upon the supposition that gas, 
while burning, not only consumes a considerable 
proportion of the oxygen of the air, but gives off 
certain injurious products of combustion. This 
may be true to a certain extent, but the disadvan- 
tages are greatly discounted by the increase in 



THE NURSERY. 



67 



convenience and the greater safety, so far as causing 
fire is concerned. 

Gas certainly may be used in the late afternoon 
and evening ; so far as the night hours are con- 
cerned, should a light be constantly required, the 
best means of obtaining it is from one of the regular 
night lights. 

A very admirable form of such lights is shown 
in Fig. 7. This light, called the " Pyramid Night 

Fig. 7. 




NIGHT LIGHT. 



Light/' consists of a low, brass stand, having a 
movable pyramidal glass chimney, and provided 
with a porcelain cup upon which the candle rests. 
The candle itself is about one inch and a half in 
height and breadth, and is so constructed that the 
combustible material is completely incased in a fire- 
proof plaster-of-Paris cup. Each candle will burn 
eight or ten hours. These lights are perfectly safe 



68 HYGIENE OF THE NURSERY. 

and may be utilized for the further purpose of 
keeping food or water warm. 

For occasional use at night, nothing can be 
better or of more ready service than gas. 

The safest way to make a light is to use a safety- 
match, and the taking of a flame from an open fire 
or the use of ordinary friction matches are danger- 
ous and to be strongly discouraged. 

Furnishing. — This heading may be made to 
include the finish of the floor, walls and ceiling, as 
well as the necessary articles of furniture and their 
arrangement. 

The floor, which ought to be laid with good 
yellow pine boards, should have a hard finish. To 
accomplish this, the crevices between the boards 
and all the nail holes must first be filled with putty, 
then, after this has dried, coated with a rapidly- 
drying, hard shellac varnish, next sandpapered, 
when the varnish has had time to harden thor- 
oughly, and, finally, finished by a second coat of 
shellac. This gives a light-colored floor that 
brightens the room and at the same time is readily 
cleaned. A dark staining, besides being sombre, 
always looks soiled. A painted floor is not easily 
cleaned. Should either of the latter be already in 
a nursery, their defects may be overcome by a 
well-laid parquet floor. 

A carpet tacked to the floor is not to be recom- 



THE NURSERY. 69 

mended ; far better is it to have rugs, which can be 
frequently taken up and well shaken, the house- 
maid having in the meanwhile free access to the 
floor itself. 

Paint is the best finish for the walls. Individual 
taste will of course weigh in the selection of the 
color and amount of decoration, though a light tint, 
but still one not trying to the eyes, is most desirable. 
Next to paint, varnished paper is to be preferred. 
Within the past few years light and soft tinted 
fabrics, covered with the representations in figure 
of familiar nursery legends, have been for sale by 
paper dealers. Such papers render the nursery 
attractive to older children, and, to a great extent, 
take the place of pictures. Paint, however, has the 
advantage, in that it may be washed and thoroughly 
disinfected in case of the occurrence of contagious 
disease. 

To return to the subject of pictures, it is best to 
interdict any that are valuable or expensively 
framed. A few highly-colored, striking prints 
taken from one of the good weekly illustrated 
papers, and fixed to the painted wall by glue, will 
give as much pleasure to the childish eyes as the 
works of the best artists. They can, too, be 
changed from time to time, and after exposure to 
contagious germs can, without regret, be removed 
and burned, in the process of cleaning. 



JO HYGIENE OF THE NURSERY. 

The ceiling of the rooms should always be painted 
with some light color, and be perfectly free from 
ornamentation. 

In the matter of furniture, the day nursery should 
contain a table at which the older children may take 
their meals or use in play and study ; one or more 
large chairs and several small ones ; a plentiful 
supply of toys and picture books, and, if there be 
room enough, a chest of drawers or wardrobe for 
clothing, and so on. All the furniture must be 
plain, that it may be more easily kept clean. 

The centre of the room must be kept clear, to 
give an opportunity for play. The table, therefore, 
should be a folding one, that it may be placed out 
of the way against the wall and take up the least 
space possible when not in use. Any other heavy 
article of furniture must also occupy a position 
against the wall and be fitted with castors, so that 
it can be readily moved to facilitate cleaning the 
floor beneath. 

The toys may vary in character with the age of 
the child — soft, white India-rubber ones for infants, 
more complicated mechanism for older children ; 
but inexpensive toys are the best, because they can 
be most frequently changed. The same is true of 
books. For both, by the way, there should be a 
special drawer or closet provided, where they can 
be put out of the way when not required. 



THE NURSERY. J\ 

A few plants, a bird or a globe of fish add bright- 
ness to the child's room and greatly assist in culti- 
vating good taste and in affording amusement. 

The night nursery must contain the beds, the 
bathing and toilet utensils, several chairs — one 
being a rocker — a small table, a medicine closet 
and a chest of drawers or other convenient recep- 
tacle for clothing and extra bed covering. 

It is essential to have a separate bed for the nurse 
and one for each child ; they should be placed so 
as to be protected from any chance draught of air, 
be far enough apart to allow of a free passage be- 
tween, and the bed of the youngest, or of an ill child, 
ought to be nearest the one belonging to the nurse. 

Old-fashioned pitchers and basins are to be pre- 
ferred to stationary washstands. The latter, though, 
are so convenient — especially when supplied with 
hot- and cold-water faucets — that they may be per- 
mitted when the waste pipe is short and runs directly 
through the wall into a rain spout, instead of com- 
municating with the sewer, and when the nurse can 
be trusted not to use them as a convenient means 
of disposing of the ordinary chamber waste. 

Each child should have his or her own brushes, 
combs, sponges, soap and towels, and all of them 
must be kept clean and sweet and have a place of 
their own. 

The medicine closet must be allowed to contain 



*]2 HYGIENE OF THE NURSERY. 

only such articles as may be often required, and 
can be used with safety by a person of average in- 
telligence; for example, olive oil, vaseline, oxide of 
zinc ointment, talcum powder, soda mint, sweet 
spirits of nitre, syrup of ipecacuanha, chalk mix- 
ture, etc. Any preparation containing opium — 
even paregoric — is especially out of place in the 
nursery medicine chest. 

Feeding bottles, implements for the heating and 
preparation of food and for bathing, also belong to 
the furniture of the nurseries, but their consideration 
may be conveniently postponed to later sections. 

Heating. — Each room requires an accurate ther- 
mometer, so hung that it may record the mean tem- 
perature ; not too close to the fireplace nor the 
windows, where it runs the chance of being unduly 
heated or chilled. 

The temperature of the day nursery should range 
between 68° and 70 F., that of the night nursery 
from 64 to 68°. 

The proper method of heating is by an open fire- 
place in which either wood or coal is burnt. Either 
of these fires is superior to a furnace, simply because 
they serve a double purpose, namely, heating and 
ventilating. My personal preference is for an old- 
fashioned hearth, where oak or other quietly burn- 
ing logs can be used, since a wood fire is more 
readily lighted and regulated, and is a better venti- 



THE NURSERY. 73 

lator than one of coals. Still, in our climate, with 
its manifold and sudden changes, it is so essential 
to have a source of heat constantly at hand that it 
is difficult to banish the furnace register from any 
living room. Therefore, while recognizing the dis- 
advantage of furnace heat, in that it makes the air 
too dry, it is well to supply the nurseries with both 
means of heating, using the open fire in moderate 
weather and the furnace only in the presence of 
severe cold. 

Tn my experience, where the nurseries are so 
situated as to receive direct sunlight through ample 
windows, there is rarely any need of furnace heat 
except in the early morning, before the servants 
have time to make up the wood or coal fire. 

Care must be taken to guard every open fireplace 
with a high fender, one that can neither be knocked 
down nor climbed over by an active child. 

Ventilation. — In addition to furnishing ample 
space in the nurseries, it is necessary to provide a 
constant supply of fresh air by ventilation. 

By all odds the best ventilator is an open fireplace 
in which wood is burnt. Such a fire, by creating a 
draught up the chimney, carries off the impure air, 
and there are few doors and windows so closely 
fitting that they prevent the entrance of fresh air 
to supply the place of that so removed. 

Should this not prove sufficient, one of the 



74 HYGIENE OF THE NURSERY. 

windows may be utilized, the upper sash being 
slightly lowered and the lower sash slightly raised, 
the openings being sufficient to allow of the entrance 
and exit of air, but not enough to cause a current 
or draught in the room. 

When the rooms are heated by a furnace or stove, 
some permanent ventilator must be used. For the 
egress of foul air an opening may be made in the 
chimney at a convenient distance from the floor; 
this may be guarded by an ordinary adjustable 
register, such as is used to regulate the entrance 
of heated air from the furnace flue. 

The same purpose may also be accomplished by 
making an opening in the upper part of the door; 
this should be guarded by a movable sash, or by 
one of the ventilating appliances to be mentioned 
later. 

To allow of the free entrance of pure air, one of 
the glass lights may be replaced by a plate of tin 
having a multitude of minute perforations, or a 
ventilator made to fit the window may be used. 

The best of these are shown in the four following 
figures. 

One apparatus, Fig. 8, consists of two pieces of 
board, one of which slides upon the other, so that 
it may be readily adapted to any breadth of win- 
dow frame. Each portion has a circular opening 
to which is fitted a tin or sheet-iron pipe, eight 



THE NURSERY. 



75 



inches long by four inches in diameter, and having 
a slight upward bend. These pipes are provided 
with a solid diaphragm, Fig. 9, readily moved by a 



Fig. 8. 




WINDOW VENTILATOR. 



Fig. 9. 




WINDOW VENTILATOR IN PROFILE, SHOWING DAMPER. 

handle, and intended to regulate the quantity of air 
admitted. When in position, the pipes, of course, 
project inward. 



7 6 



HYGIENE OF THE NURSERY. 



The wheel window ventilator, Fig. 10, consists of 
a movable diaphragm and a revolving wheel, the 
whole varying from six to eight inches in diameter. 
When placed in position, which is readily done by 
cutting a circular hole in a window pane or in the 
door, the difference in temperature between the 
interior and exterior of the rooms will create a 

Fig. io. 





WHEEL VENTILATOR. 



current, and cause the wheel to revolve noiselessly. 
The revolving wheel, while it prevents a draught, 
allows of the passage of two currents, that of fresh 
air inward and foul air outward, and the diaphragm 
enables one to control the supply of air. 

An admirable domestic arrangement for ventila- 
tion consists of a board eight or ten inches in 



THE NURSERY. 



77 



height placed across, and close to, the window sill, 
as in Fig. 1 1 . 

This, when the lower sash is raised, as indicated 
by the dotted lines, allows of a free entrance of air 
without a draught, the current being directed up- 
ward (as shown by the arrows). 

Together with the above careful provision for 
constant purification of the atmosphere, it is essen- 



FlG. II. 




BOARD VENTILATOR IN PLACE. 



tial to "air" thoroughly both of the nurseries 
through widely opened windows. With the day 
nursery this must be done whenever the child 
leaves it for any length of time, care being taken to 
close the windows, and get the temperature to the 
proper degree before his return. The night nursery 
should be aired after the children leave it in the 
morning, and after the mid-day nap. 



78 HYGIENE OF THE NURSERY. 

The air of the nurseries should, of course, never 
be unnecessarily contaminated. Cooking or smok- 
ing in the rooms are to be especially avoided. In 
regard to the latter, there is no doubt that children 
are often made sick by the fumes of tobacco, and 
that, of all forms, cigarette smoke is the most 
injurious. 

Cleaning. — It is hardly necessary to say that the 
nurseries must be kept perfectly clean. Napkins 
and bed clothing that have been soiled by the dis- 
charges from the bladder or bowels must be re- 
moved at once from the room, and the practice of 
hanging diapers wet with urine before the nursery 
fire to dry should be emphatically discouraged. 
Equal care must be taken to promptly empty and 
clean chamber vessels after use. 

The furniture, woodwork and window glass, as 
well as the floors, must be kept clean and free from 
dust by wiping with a damp cloth at least once a 
week. 

Should there be a stationary washstand in either 
room, it is most important to thoroughly clean the 
basin every day, and to disinfect the waste pipe, how- 
ever short it may be, twice every week. The latter 
maybe done with ammonia, copperas or Piatt's Chlor- 
ides. The process is very simple, and consists in 
pouring down the pipe a gallon or more of a diluted 
solution of either of the above articles. Copperas 



THE NURSERY. 79 

is the cheapest and in my opinion the best; a double 
handful of it in an ordinary bucketful of water 
forms an efficient disinfectant and deodorizer. 

The substance known as Household Ammonia 
may be employed in the strength of two table- 
spoonfuls to a gallon of water, and is especially 
useful where there is a suspicion that the interior 
of the waste pipe has become coated with a layer 
of soap. 

Piatt's Chlorides is used in the proportion of one 
part to four of water, and is very efficient, though 
more expensive than either of the other materials. 

The nurseries must never be cleaned whilst the 
children are occupying them. 



HO HYGIENE OF THE NURSERY, 



CHAPTER III. 

THE NURSE-MAID. 

While the mother is the natural guardian of the 
physical and moral welfare of her children, the 
nurse-maid has a considerable influence over both; 
for the former, however anxious and watchful, has 
so many other duties, both domestic and social, 
that she must absent herself at times from the 
nursery; the latter, on the contrary, lives there. 
By day, and often, too, at night, she has the care 
of the children, attending to their apartments, to 
their persons, food and clothing, participating in 
their amusements and exercise, and watching over 
their sleep. The selection of a nurse-maid, there- 
fore, is a matter of much importance. 

The celebrated Dr. West, in discussing the nurs- 
ing of sick children, makes the following statement 
in regard to a nurse's qualifications: "Indeed, if 
any of you have entered on your office (hospital 
nursing) without a feeling of very earnest love to 
little children — a feeling which makes you long 
to be with them, to take care of them, to help 
them — you have made a great mistake in under- 
taking such duties as you are now engaged in." 



THE NURSE-MAID. 8 1 

Now, though this was addressed to those who 
were occupied in caring for ill children, it is alike 
applicable to the nurse whose chief duties are with 
the healthy. 

Love of children, therefore, is essential in a good 
nurse, but it must be combined with several other 
traits of character, since love alone will not com- 
pensate for such faults as stupidity, inexperience, 
forgetfulness and lack of judgment. 

What, then, are the qualifications to be sought 
for? 

ist. The woman should be in the prime of life, 
between twenty-five and fifty, for example. For if 
she be under the former age, she is apt to be frivo- 
lous and think more of her " afternoon out " and of 
her male friends than of her charge, while if over 
the latter, besides being set in her ways and opin- 
ionated, she is usually too worn out for efficient day 
service and too prone to heavy sleeping to be trusted 
for night duty. 

2d. Strength, activity and freedom from disease 
are necessary. The first quality does not always 
go with a large accumulation of flesh ; in fact, the 
reverse is apt to be the case. A stout nurse looks 
motherly and comfortable in the nursery, but she 
may, by her very bulk and consequent heat-pro- 
ducing power, render a young infant wretched in 
warm weather. I should avoid such an one as 
6 



82 HYGIENE OF THE NURSERY. 

much as I should another whose back pained when 
she swept the floor or carried the baby out for an 
airing. 

Consumption of the lungs, indicated by a cough, 
and syphilis, indicated, usually, by an eruption 
upon the skin, are two diseases to be especially 
avoided. Besides these two, which are to be 
shunned because they positively endanger the 
child's health, there are others that, without doing 
appreciable harm, render the sufferer's presence 
unbearable in the nursery. These chiefly offend 
through the sense of smell, as in the case of old 
leg ulcers ; too freely perspiring feet ; over-active 
axillary glands; certain forms of chronic catarrh 
of the nose, throat or nostrils ; and of decayed or 
badly kept teeth. 

3d. While beauty is not to be specially sought 
after, the maid's face should, at least, h^ve a cheer- 
ful expression. A markedly homely or sinister 
face is a disadvantage, and still more so is any 
decided deformity. This reference to personal 
appearance, at first sight, perhaps, seems trivial, 
but any one who has seen much of children can- 
not fail to have noticed how a young child will 
crow and hold out its arms to the bearer of a 
placid, comely and smiling face, and turn away 
from one that wears a sombre and unsympathetic 
expression. Much is said about the magic of touch 
in managing young children, but I have observed 



THE NURSE-MAID. 83 

that their eyes always seek the face and eyes of 
those about them, and that it is what they see there 
that guides their instinct for like or dislike. 

4th. Children resemble dogs and horses so far as 
the instinct of knowing those who love them is 
concerned, and the element of love toward babies 
is, as already hinted, the most important feature in 
the disposition of a nurse. A woman having this 
quality will never be cross or impatient, and, by the 
very contagion of her good nature, prevents her 
charges from being fretful and makes her nursery 
happy. Besides love, with the patience and con- 
sideration it implies, truthfulness is a most import- 
ant trait of character, n'ot only for the physical 
welfare of the child, but also that, since children 
are such imitative creatures, the bad habit of lying 
may not be formed. 

A truthful, loving woman is generally a cheerful 
one ; if not, her place is out of the nursery, for 
children must be happy to be healthy, and the 
constant contact with sadness will bring unhappi- 
ness to any child. 

Gentle speech is also a desideratum. Children 
will never learn politeness if every sentence they 
hear in the nursery is spoken in the fewest, shortest 
words, and " please " and " thank you " are good 
elements of a nurse's conversation. 

5th. The nurse-maid should have a sufficiently 
developed mind to follow out and remember gen- 



84 HYGIENE OF THE NURSERY. 

eral directions, whether given by the physician or 
mother, and to do routine work without constant 
supervision. A certain amount of experience is a 
good thing, and on this account it is a recommend- 
ation for a woman to have had a partial hospital 
training, to have nursed children before, or to have 
been a mother. On the other hand, one must 
beware of the self-opinionated maid, who, having 
cared for several children, thinks she knows every- 
thing, and will be controlled by neither professional 
nor maternal directions. Such women are as igno- 
rant and inefficient as they are common. 

6th. Cleanliness is essential in a nurse. A slov- 
enly maid will keep neither her children nor th 
nurseries clean. Therefore insist upon the nurse 
not only washing her face and hands as occasion 
requires, but upon her bathing her whole body two 
or three times a week, and upon her wearing fresh, 
well-aired clothing. 

7th. So far as habits are concerned, absolute 
temperance and early rising are the most desirable. 
Early rising, however, implies an early hour of 
retiring, and care must be taken to afford ample 
facilities for so doing. 

8th. Every nurse-maid should be impressed with 
the importance of informing the parents of all con- 
ditions connected with the health of the child that 
may demand attention, and of revealing at once 
any injury that may have been sustained. 



CLOTHING. 85 



CHAPTER IV. 

CLOTHING. 

In introducing this subject, it may be well to call 
attention to two important points that are often 
either unrecognized or overlooked. 

1st. All children, but particularly infants, have 
little power to resist the depressing influences of 
continued cold, and on this account require warm 
clothing. 

Too much cannot be said against the fashion 
which, for the sake of supposed beauty, demands 
that children should be dressed in a way to leave 
their legs and knees bare. Even in the house, 
and except in extreme tropical weather, this bar- 
barous practice is injurious, as it exposes a con- 
siderable part of the body to constant chilling. 
The physician knows, and the intelligent layman 
should be readily convinced of, the bad effects of 
such protracted abstraction of body-heat. The 
explanation is simple : every child is supplied by 
nature with a certain definite quantity of nerve 
force destined to be expended each day in main- 
taining what physiologists term " the functions of 
the body," namely, breathing, circulation of the 



86 HYGIENE OF THE NURSERY. 

blood, digestion, heat-production, and so on. Now, 
if an undue proportion of this nerve force be con- 
sumed in producing body-heat, as must be the case 
when so large a surface is left bare, the other 
functions will be robbed of force. From this rob- 
bery the digestion suffers most. With feeble diges- 
tion comes constipation or its opposite, diarrhoea. 
Again, if the surface be chilled, the blood which 
should circulate in the skin is driven to the interior 
of the body, and the vessels of the mucous mem- 
brane become surcharged. This surcharging, or 
congestion, causes the condition known as catarrh, 
which, affecting the lining membrane of the alimen- 
tary tract, causes vomiting and diarrhoea ; and, in 
the case of the lungs, bronchitis. 

Mothers who allow their children to have their 
legs and knees covered with the " hideous " long 
stocking or drawers, often come to me and com- 
plain that Mrs. So-So's children have bare legs, and 
are even healthier and more robust-looking than 
theirs. Some children are born hardier than others, 
but no one knows, in the long run, how much better 
in health, in after life, are those whose vital forces 
have been husbanded and strengthened in infancy 
and childhood. I cannot waver in my opinion. I 
have been too often called to the bedside of these 
poor little " robust " children whose health, and even 
life, had been spared had their clothing been better 



CLOTHING. 87 

adapted to their tender years. One great argument 
advanced by the advocates of bare knees is that in 
olden time all children were clad with their arms 
and neck, as well as knees, bare. No one says 
how many died by the wayside. What mother 
would, on a winter's day, care to sit on the floor or 
walk through the halls with her own knees un- 
covered ? The mother who protests the loudest 
I have always observed to be warmly dressed 
herself. 

2d. Infants and children have soft tissues. This 
statement applies as well to the bones as to the 
muscles. Therefore, the clothing should fit loosely, 
that it may not interfere with the motion of the 
limbs, with the rise and fall of the chest in respira- 
tion, or with the necessary freedom of the muscles 
of the abdominal wall or intestinal canal, one of 
which is concerned in respiration, the other, in the 
no less important function of digestion. 

Let the clothing, then, be warm and loose. 

Thought for the infant's clothing must begin 
before its birth, with the filling of the " baby's bas- 
ket." This should contain the following articles : — 

A nainsook slip. 

A flannel skirt. 

A merino shirt, high neck and long sleeves. 

A flannel band, twenty-two inches long and six 
inches wide. 



88 HYGIENE OF THE NURSERY. 

A soft woolen shawl, to be used for a wrap in 
cold weather. 

Worsted socks. 

Two linen diapers. 

Large and small safety-pins. 

One pair blunt-pointed scissors. 

Two soft towels. 

Castile soap. 

Small silk sponge. 

Powder box and puff. 

Soft hair-brush. 

Cold-cream or vaseline. 

Linen bobbin. 

Fine old linen, for infant's mouth. 

So soon as the child is born and the cutting of 
the cord frees it from maternal connection, it is the 
rule to wrap it in a piece of soft flannel and place 
it in a position of safety until, certain necessary 
attentions having been rendered to the mother, a 
convenient time arrives for washing. After this 
operation, which will be described on a future page, 
the child is dressed for the first time. Every infant 
requires knitted worsted shoes, or, as they are 
popularly called, " socks," a napkin and an abdom- 
inal belt or " binder;" the rest of the dress — the 
body-clothing proper — consists usually of three 
garments, which vary in pattern with individual 
ideas and tastes. 



CLOTHING. 89 

The " socks'' are made of silk thread or soft 
worsted yarn fashioned by needles into the shape of 
shoes, and of such a size as to fit the foot loosely, 
while covering the leg two inches or more above 
the ankle. They are held in position by a loosely 
tied tape or a narrowed band of stitches — the 
mechanism of which every knitter will understand 
— near the top. Stockings are unnecessary, and 
are rarely used before the clothes are shortened. 

The napkin or diaper may be made either of 
linen or muslin, the former material being preferred, 
as it is less heating and less liable to cause chafing 
of the skin when wet. It must be folded in such a 
way that it may not cause pain by undue pressure 
upon the back or abdomen. 

A soiled napkin can never be safely used a second 
time, even though the soiling medium be simply 
urine and the subsequent drying be thorough. In 
consequence, an abundant supply is essential. The 
least dampness renders its use dangerous, and 
while insisting upon the washing of all soiled 
napkins, it is equally important that they be aired 
for at least twelve hours before being used again, 
that they may be surely dry. One must be most 
careful, too, to insist upon the laundress using only 
pure soap and avoiding soda in washing, for the 
constant contact of diapers impregnated with irri- 
tating substances is sure to produce troublesome 



90 HYGIENE OF THE NURSERY. 

excoriation of the buttocks and neighboring deli- 
cate skin. 

The "binder" may be of fine, soft flannel or of 
knitted wool. In either case it should extend from 
the brim of the pelvis or hip bones to the lower 
ribs. I prefer a knitted band made narrower in the 
centre than at either extremity. Any woman who 
is apt with her knitting needles can make one, and 
the product has the advantages of being readily 
applied and of keeping its position without the aid 
of either strings or pins.* When a flannel band is 
preferred, it should be wide enough to cover the 
same area, and long enough to go a little more 
than around the abdomen. It is best fixed in posi- 
tion by two small safety-pins. Such a band is dif- 
ficult to keep in place, collects more perspiration 
than the more net-like knitted binder, and the 
necessary pins may cause inconvenience. 

Several bands are required to be on hand at the 
same time for the sake of proper cleanliness, and, 



* Formula for Crochetted Baby-band. — -Single zephyr in ridge 
stitch, that is, half stitch, in which, going back and forth, only the 
back half of the stitches in the lower row are picked up. Begin 
on a chain of fifty and crochet forty- eight ridges, hence ninety- six 
rows. Join by a row of tight stitches or by sewing. Finish off at 
bottom by a row of plain stitches and at top by a picot-edging (five 
chains and a tight stitch back into the first). — " Babyhood," Vol. 
ni, p. 33- 



CLOTHING. 91 

as they should be worn up to the end of the second 
year, it is necessary to replace them, set by set, as 
the growth of the child demands. 

The body-clothing is usually composed of three 
separate pieces : a shirt, a petticoat and an outside 
dress or " slip." The shirt should be long enough 
to extend from the neck to the lowest part of the 
trunk and have sleeves reaching to the wrists. It 
may be made of merino or of soft worsted yarn. 
In either case it should fit. loosely and be fastened 
at the neck with tape or buttons. The petticoat 
must be long enough to extend from the waist to 
six or eight inches below the feet. The proper 
material for the skirt is light, white flannel. This 
is gathered at the top into a muslin band, which 
must be deep enough to reach from the hips to the 
arm pits, and wide enough to lap over considerably 
at the back; it is fastened by small safety-pins. 
The over-width is to allow for increase in size. 

An equally good waist can be made with arm- 
holes and buttoned in the back. 

The dress or slip is made of fine cambric, cut in 
one piece, opening well at the back that it may be 
readily slipped on and off. 

Another, and I think a preferable outfit, consists, 
also, of three garments. The first or under gar- 
ment, made of soft, white flannel, is long enough to 
extend from the neck to ten inches below the feet 



$2 HYGIENE OF THE NURSERY. 

— about twenty-five inches in total measurement — 
with wide arm-holes. All the seams must be 
smooth, and the hem at the neck turned outward. 
The next garment, cut in the same way, but one- 
half inch larger, and five inches longer, is made of 
muslin. The slip is also cut " Princess," has long 
sleeves, a longer skirt than either of the other gar- 
ments, and all are fastened behind by small buttons. 

When dressing the infant these three coverings 
are put together, sleeve fitting to sleeve, and the 
whole passed over the little one's head, then but- 
toned behind, and the process is complete. 

The advantages of the last method of dressing 
are: — 

1st. Perfect freedom to the organs contained 
within the chest, abdomen and pelvis. 

2d. Suspension of the clothing from the shoul- 
ders. 

3d. Saving of time to the mother and fatigue to 
the infant in the process of dressing. 

4th. A uniform covering of the whole body. 

So much for the day clothing. At night the 
dress should consist of the flannel and the outer 
garment. 

In the foregoing, my intention has been to lay 
especial stress upon the advantage of holding the 
garments in place by tape or buttons rather than by 
pins, and it should be noticed, that a baby may be 



CLOTHING. 93 

completely dressed with but one pin in its clothing, 
namely, that fastening the napkin. This, which is 
allowed only for the sake of convenience, must be 
a safety-pin, the ordinary pointed pin being an 
abomination in the nursery. 

It is hardly necessary to say that, for the sake 
of cleanliness, an abundant supply of body-clothing 
should be at hand ; a mother, particularly, must 
recognize that " cleanliness is next to godliness," 
and provide accordingly. Let her remember, too, 
that fresh clothing must be thoroughly " aired " or 
dried before it is put upon the infant. 

Sometimes, to keep the body-clothes dry, a piece 
of thin rubber cloth is placed over the napkin; this 
does nothing but harm, for it over-heats the parts, 
and when the diaper is wet with urine, makes a 
poultice of it, and thus macerates the skin and 
causes irritating and painful excoriation. 

At the age of six months in summer and of eight 
months in winter, provided, in both cases, the health 
be good, the clothing may be " shortened." This 
change introduces several important questions, 
namely, the covering of the legs and knees, and the 
selection of shoes and stockings. 

The shortening process makes no change in the 
body-clothing except that the skirts end a short dis- 
tance below the knees, at about the point to which 
an ordinary shoe top comes ; this, of course, prac- 



94 



HYGIENE OF THE NURSERY. 



tically leaves the legs, from the top of a short stock- 
ing to the lower edge of the napkin, exposed. As 
already hinted, it is necessary for the health of the 
infant to keep this comparatively large surface pro- 
tected, except, perhaps, during a few extremely 
hot days in mid-summer. There are two ways of 
accomplishing this : either by drawers or by stock- 

FlG. 12. 




DRAWERS. 



ings long enough to extend from the feet to the 
napkin, to which they may be attached by safety- 
pins or ordinary " fasteners." The best drawers are 
those made in two pieces, one for each leg, as shown 
in Fig. 12. 

These, as furnished in the shop, are made of 
merino, but any clever woman should be able to 



CLOTHING. 95 

cut them out of Canton flannel and make them at 
home. They must fit the legs moderately closely, 
and have a buttonhole at the top, so that when 
passed over the napkin they may be buttoned to 
the waist of the skirt on its inner side, and so be 
held up. These drawers are not readily soiled, as 
they cover the legs only, and the napkin comes be- 
tween. They must, of course, be made of material 
to suit the season — heavy in winter, light in summer. 
When stockings alone are used they must be 
long enough to come well above the knees, and 
should be held in position by " supporters" instead 
of garters, since the latter, being necessarily tight, 
bind the limbs, and often, by interfering with free 
circulation, cause cold feet. The supporter must 
be adjusted to make only the required amount of 
traction, and this always in a direction parallel with 
the axis of the body. The stocking foot ought to 
fit easily, but without wrinkling, and at the same 
time have a rounded rather than a conical-shaped 
toe. For although the silk, woolen, or cotton 
material of which the stocking is composed may be 
yielding, it is elastic, and consequently capable of 
exerting a certain amount of pressure upon the 
foot; and there is little doubt that the persistent 
compression made by a short, sharply conical point, 
cramps the toes, crowds them together, and some- 
times, even, forces them to overlap one another. 



96 HYGIENE OF THE NURSERY. 

Colored stockings are often preferred to white, 
but they are only permissible, provided the coloring 
matter be well fixed in the texture and not of such 
a nature as to cause irritation of the skin. Every 
stocking should be turned inside out, carefully 
examined, and all knots and ends removed, the 
smallest of which hurt the tender little feet. Were 
this matter oftener looked to, many an unexplained 
tear would be avoided. 

As with the drawers, so with the hose ; several 
weights should be provided to correspond with the 
varying demands of the seasons for greater or less 
warmth, and in both cases a sufficient supply must 
be kept to allow of frequent changing. 

The shoes are prominent items of the clothing ; 
their shape, size and manner of fastening, and the 
make-up of the soles being the important matters 
for consideration. 

An infant's feet are plumper than those of the 
adult, and all the tissues, but especially the bones, 
are softer. They may be readily deformed by 
protracted pressure from badly constructed shoes, 
despite the assertions of unhandy shoemakers, who 
say that the feet are shapeless masses of fat, for 
which any leathern bag having the semblance of a 
shoe will serve as a covering. 

Throwing out the element of fleshiness, the 
characteristics of the perfectly formed baby and 



CLOTHING. 97 

adult foot do not materially differ. In the first 
place, the inner and outer margins are very different 
in contour. Secondly, the heel and middle third 
of the foot is firm and presents little mobility in its 
component bones, whereas the anterior third, in- 
cluding the toes, is very mobile. The toes again 
bear much the same relation to the rest of the foot 
as the fingers to the hand. This is particularly 
noticeable in the great toe, which, instead of inclin- 
ing toward a line passing along the centre of the 
foot, points away from it, in the same manner as the 
thumb from the hand, although, of course, to a far 
less degree. An inclination of the great toe toward 
the mid-line of the foot is undoubtedly often seen in 
adults, but in them it is a deformity resulting from 
badly made shoes, and one that gives a conical 
contour to the toes, cripples the movements of the 
great toe, and greatly interferes with the ease of 
walking, just as a contraction and permanent draw- 
ing of the thumb toward the palm of the hand 
would materially lessen the usefulness of that 
member. 

The normal position of the toes just described 
will be readily understood from the tracing of the 
sole of the right foot as shown in Fig. 13. 

The most striking features of this diagram are, 
the expanded position of the toes ; the width of the 
anterior part of the foot compared with the heel, 
7 



9» 



HYGIENE OF THE NURSERY. 



and the straight outer and curved inner margins of 
the foot. The line A B represents the axis of 
walking, which, while nearly parallel to E F, the 



B 
F \ 



Fig. 13. 
D 




C A 

TRACING OF NORMAL FOOT. 



inner edge of the foot, forms quite an angle with 
C D, the centre line. 

In the normal foot the great toe is directly in the 
axis of walking, a position in which, of course, it 



CLOTHING. 



99 



is of much greater service than if it were inclined 
inward toward the line C D. 

Now, if a line be drawn closely around the mar- 
gin of the above imprint, it will give the exact shape 
of a perfect shoe sole for the right foot; or taking 

Fig. 14. 




Left Foot. Right Foot. 

SHAPE OF PROPER SHOE SOLES. 



the imprint of both feet, we get the outlines shown 
in Fig. 14. 

On first sight, one would suppose that a shoe 
with a sole so shaped would look very awkward, 
but when made by a skillful shoemaker, it differs 
very little in appearance from those ordinarily sold 



IOO HYGIENE OF THE NURSERY. 

in the shop, with the exception that it is broader in 
the toes. 

Another important fact is clearly demonstrated 
by Fig. 14, namely, the absolute necessity of having 
the shoes made "right and left," and the fallacy of 
supposing that one or other shoe may be used on 
either foot indiscriminately. 

Besides having a correct shape, the shoes should 
be long enough not to cramp the toes and bend 
them down and backward upon themselves. At 
the same time it is a mistake to have them too 
long, allowing the foot to slide back and forth, as 
this leads to the formation of either blisters or 
corns. Let the shoe fit snugly about the heel and 
instep, and easily at the toes, and all is well. I say 
easily at the toes, because many an otherwise good 
shoe is ruined by having the uppers at the points 
too scanty, so that the toes are forced against the 
sole and subjected to painful pressure. 

The best method of fastening is by a lace, since 
this admits of making one part of the upper 
tight and another part loose, according to circum- 
stances. 

Elastic fastenings, as in so-called congress shoes, 
are not good for children ; and when buttons are 
used, the nurse must not necessarily leave them in 
the position fixed by the shoemaker, but move one 
or more as the size of the ankle demands. 



CLOTHING. IOI 

The thickness of the soles depends upon the age 
of the child. Before walking is attempted, they 
may be thin, flexible, and of uniform thickness from 
heel to toe ; afterward they should be made heavier 
and more resisting, in order to protect the tender 
feet, and should be decidedly thicker at the heel, 
that this part of the foot may be elevated. A 
clear-cut heel, however, as in boots adapted for 
adults, is not to be recommended in children's 
shoes before the age of six or eight years. 

Sometimes a careful mother may notice that, for 
a short time after stockings and shoes are put upon 
her baby t the feet are cooler than before. Undue 
pressure about the ankle, with consequent inter- 
ference with the blood circulation in the feet, is the 
cause of this, and the remedy is to remove occa- 
sionally the coverings, chafe the feet into warmth, 
and see that the shoe-top is not so tightly laced or 
buttoned as to constrict the ankle. 

So far, all that has been said of the clothing 
after " shortening " refers to the day and house 
garments. It remains now to consider the night 
dress and the extra wraps to be worn out of 
doors. 

At bedtime, all the clothing worn during the day 
being removed, the baby is washed, and after the 
application of a fresh napkin and binder, is ready 
for the night dress. This consists of a shirt and an 



102 HYGIENE OF THE NURSERY. 

especial gown. The shirt should always be of 
flannel, a light gauze in summer and a heavier 
wool in winter; its pattern may be the same as that 
worn by day, though its texture ought to be a trifle 
lighter. The best pattern of a winter night-gown is 
a long, plain slip, with a drawing string at the 
bottom, to prevent exposure of the feet and limbs, 
should the child kick off the bed covering during 
sleep. It ought to be made of flannel, or the more 
easily washed Canton flannel. In summer, a loose 
muslin slip of the same design, but without the 
drawing string, may be worn. There is even more 
temptation by night than by day to use a rubber 
cloth over the napkin, to protect the body and bed 
clothing, but never do this. 

It is a good plan to provide the child with a 
flannel garment corresponding to the dressing gown 
of the adult, and with a pair of bedroom shoes. 
The latter are composed of soft leather or felt 
soles and knitted uppers, and are fastened around 
the ankle by a soft elastic. Both of these will be 
found useful in the many occasions when the child 
has to be taken up at night. 

When dressing a child for exercise in the open 
air in cold weather, do not put on the extra, 
outer clothing until immediately before leaving 
the house, and remove it directly on returning. 
A long cloak, with or without capes or fur, accord- 



CLOTHING. IO3 

ing to the degree of cold, and a pair of long, warm 
leggings, constitute the extra covering for the 
body. Protect the head, in winter, by a close- 
fitting, thick cap; the hands, by worsted gloves or 
mittens. 

In summer the child may go out of doors in the 
same dress worn in the house, the head being pro- 
tected from the direct rays of the sun by a broad- 
brimmed, light straw hat. 

Every mother must decide for herself when her 
child is to doflf the costume of babyhood and 
assume that of the boy or girl. There are two 
points that must always be considered, however, 
namely, the time of dispensing with the napkin 
and with the abdominal belt. Abandon the nap- 
kin, and substitute ordinary drawers, as soon as 
the child can be trusted to make known the calls 
of nature — a period that varies considerably with 
the care and skill in training. The binder should 
always be worn until the completion of the eruption 
of the milk teeth, or until about the end of the 
second year. 

In clothing the boy or girl, be particular to se- 
cure warmth, freedom of movement and cleanliness. 
The first is accomplished by enveloping the whole 
body — no matter what the season — in woollen 
underclothing. This means high-necked and long- 



104 HYGIENE OF THE NURSERY. 

sleeved flannel shirts and flannel drawers extending 
down to the ankles. It is hardly necessary to 
mention that the thickness of these garments must 
vary with the seasons, but it is quite worth while 
insisting upon woollen under-garments, except 
during the very excessively hot days of midsum- 
mer. This provision being made, and the shape of 
the shoes and stockings * looked into, it matters 
little what may be the fancy of the mother in regard 
to outer clothing. 

Freedom of movement refers not only to the 
limbs, but to the chest and abdomen, which should 
never be constricted, lest the important organs they 
contain be crippled in their action. Loose-fitting 
clothes accomplish this object ; but it is to be 
understood that looseness or ease in fit does not 
necessarily imply that the dress must be awkward, 
ill-fitting and a source of mortification to the wear- 
er. On the contrary, clothes must be easy and yet 
well cut and stylish. 

To be clean, the child must have a plentiful sup- 
ply of clothing, so that changes may be made as 



* It is impossible for either a stocking or shoe to fit accurately 
unless the toe nails be kept in good order. In cutting the toe nails 
there is, as in every other affair of life, a right and a wrong way. 
Cut the nail directly across, without rounding the corners. Should 
the latter be done, the nail is apt to grow into the flesh and give 
suffering to the child and work to the surgeon. 



CLOTHING. I05 

frequently as required. Clean, cheap clothes look 
much better than soiled finery. 

The night dress of a child five or six years old 
consists, during winter, of a light, high-neck and 
long-sleeve merino shirt and night drawers of Can- 
ton flannel; in summer, of a gauze undershirt, with 
short sleeves and muslin night drawers. 

Cold weather calls for a warm overcoat, hat, 
mittens and leggings, or rubber boots in wet or 
snowing weather, when the child leaves the warmth 
of the house. Should the cold be so great as to 
necessitate ear tabs and a neck wrap for protection, 
a child under six years is better off in the nursery. 

As to rain-proof clothing, and our climate calls 
often for both rubber boots and a long mackintosh, 
it must be remembered that such coverings, while 
impervious to moisture from without, are no more 
pervious to body moisture or, in other words, to 
perspiration, which secretion they encourage by 
their warmth. Of course, when perspiration is re- 
tained, the underclothing becomes moist, and there 
is a great risk of surface chilling and consequent 
catarrh. Therefore, it is a good plan, when water- 
proof garments have been worn for any length of 
time, to take off the underclothing as soon as shel- 
ter is reached, to rub the surface into a glow with a 
coarse towel and then redress the child. 



106 HYGIENE OF THE NURSERY. 

Before concluding this chapter, let me advise 
that the change from winter to spring or summer 
clothing be not made at any fixed date, under the 
supposition that it is the time to change, and the 
weather should be warm, whether it is or not. In 
our Eastern climate it is unusual to have settled, 
warm weather until June. May has a certain num- 
ber of warm days, but they are quickly followed 
by cooler ones. Consequently the safe^ plan is to 
keep on the heavy winter flannels until hot weather 
surely sets in, changing, in the meanwhile, the 
outer clothing to suit each day. 



EXERCISE AND AMUSEMENTS. 107 



CHAPTER V. 

EXERCISE AND AMUSEMENTS. 

Healthful exercise, especially when taken in the 
open air and sunshine, invigorates the nerves; se- 
cures an active performance of such vital functions 
as circulation, respiration and digestion ; maintains 
a hearty appetite and regular movement of the 
bowels, and develops the muscles. 

Symmetry of development is essential, and on this 
account any exercise or play that brings but one 
or a few sets of muscles into action, must be dis- 
countenanced. The muscles control the bones, and 
should one set be comparatively feeble, the bones 
they move are dragged out of form by stronger 
opposing sets. Probably the most important groups 
of muscles to render strong are those of the back 
which hold the spine in proper position. When 
these are weak — the greatest weight of the trunk 
being toward the front — the backbone has a ten- 
dency to be drawn forward in such a way that the 
movements of the chest are crippled, and respira- 
tion so interfered with that the blood is imperfectly 
aerated, nutrition fails, and the child becomes a 
weak, puny invalid. 



108 HYGIENE OF THE NURSERY. 

Curvature of the spine — the deformity here re- 
ferred to — may also interfere with other functions ; 
for instance, digestion, elimination of urine and 
the motion of the legs. Bone deformities are more 
apt to occur in children than in adults, because, in 
the former, the bones, not being thoroughly set 
and hardened, are more readily influenced by 
irregular muscular action. 

Marking, then, the necessity for equal muscular 
development, the subject of exercise may be taken 
up in detail. 

The first exercise the infant gets will be in the 
nurse's arms. Shortly (three or four days) after 
birth the babe may be taken from its crib two or 
three times a day, and, being placed upon its back 
on a pillow, carried about the room for ten or fifteen 
minutes. In the second month, longer walks may 
be taken, the pillow being discarded and the infant 
carried in a reclining position in the arms, with the 
head and body thoroughly supported. 

By the fourth month the child will have gained 
sufficient muscular strength to maintain a sitting 
posture for a short time, provided the head and 
shoulders be supported by the nurse's hand, and in 
this way it may be carried about on the right or 
left arm — and it is most important not to use one 
arm constantly — for its daily training. 

At the end of the eighth month a healthy child 



EXERCISE AND AMUSEMENTS. IO9 

ceases to require support to the head and back 
when carried, but not before. 

After the infant ceases to be merely a sleeping 
and eating animal, and begins to show signs of 
humanity, at about the fourth month, for example, 
he should be laid upon a soft mattress or sofa sev- 
eral times each day and allowed to do as he pleases. 

Under these circumstances, he rolls about and 
kicks his legs, clasps and unclasps his fists, moves 
his arms, and crows or cries. All of these move- 
ments serve a purpose ; the legs gain strength for 
future walking; the hands, for grasping; the arms, 
for carrying, and the vocal organs, for speaking. 

A certain class of nurses seem unable to com- 
prehend that a baby is a tender creature; tender 
not only in age, but in the texture of all its tissues. 
They support a young infant upright upon their 
knees and violently jolt it up and down, under the 
supposition that it gives pleasure, and should the 
child cry they add to its torment by a peculiar 
" song." Gentle movement is as pleasant to the 
child as riding in an easily running carriage on a 
smooth road to an adult; knee-jolting as unpleas- 
ant and harmful as a journey over the worst cor- 
duroy road. The so-called singing must cause 
only pain. 

The question of out-door exercise arises soon 
after birth. Daily airings are requisite for perfect 



IIO HYGIENE OF THE NURSERY. 

health so soon as the child has arrived at the proper 
age, and providing always that the weather be 
favorable. The fifth month is the proper age for 
children born in the early fall and winter, and the 
second month, for those born in summer. In cool 
weather they should be taken out in a baby carriage 
or in the nurse's arms, for an hour in the morning 
and half an hour in the afternoon, while the sun is 
shining. In summer, they may pass the greater 
part of their waking hours in the open air. In 
damp and rainy weather, when there is a strong 
east or north wind blowing, or when the mercury 
stands below 20 F., young children are better off 
in the nursery. The hardening process, in our 
climate, so far from being successful, usually results 
in an attack of bronchitis or something worse, 
which may house the child for a long time, and 
thus deprive him of the advantage of subsequent 
favorable weather. 

How shall the baby be taken out? The answer 
to this question involves the consideration of two 
points, namely, the clothing and the means of con- 
veyance. The former has already been referred to. 

As to the method of conveyance, the arm is to 
be preferred for very young infants, especially in 
cold weather, because they are apt to be uncomfort- 
able in a baby carriage, and because as they must, 
when carried, be held close to the nurse's body, 



EXERCISE AND AMUSEMENTS. I I I 

they are kept warm by the heat given off from the 
bearer. 

After the fourth month a carriage may be used. 
Now there are good and bad baby carriages, as well 
as a right and a wrong way of trundling them; and 
here again the mother must not forget that the baby 
is a tender creature and very easily hurt. 

The best kind of carriage is none too good for 
the load it is destined to carry. It should run 
smoothly, without jolt or jar; its wheels should be 
kept from creaking by the frequent application of 
some mineral oil, as " sewing-machine oil;" the bed 
must be soft and comfortable, lateral support being 
given to the body by two long, narrow and soft 
pillows ; the infant must never be strapped down, 
and the parasol must be always at hand, and so 
arranged as to shade the tender eyes from bright 
sunlight. 

While the carriage is a convenience to the nurse, 
it is never to be regarded as a place of security for 
the child, to be left on the sidewalks or in windy 
places while the wheeler exchanges gossip with 
fellow-nurses or enters a house to visit friends. 
However good its springs may be, they are never 
easy enough to allow of rude jolting or of mount- 
ing a raised curbstone by mere dint of hammering 
and muscle force. 

After the age of nine or ten months, a healthy 



112 HYGIENE OF THE NURSERY. 

child will begin to creep; at the end of a year he 
will make efforts to stand, and from four to eight 
months later will be able to walk by himself. Chil- 
dren, however, present great differences in this 
respect, and a delay of a few months must not be 
considered abnormal. Second children are usually 
more active than those born first, since they imitate 
and are encouraged by the example of their elders. 

So soon as efforts at creeping are made there 
need be no fear that insufficient exercise will be 
taken ; the care should be, rather, to prevent over- 
fatigue, as the babe, delighted by its new-found 
powers, will be inclined to exert them all day long. 

So soon as creeping begins, the question arises 
whether or not the nursery floor is a permissible 
field for exercise. This depends entirely upon the 
child's health, the state of the weather and the con- 
dition of the nursery. Remember always that the 
stratum of air next to the floor is much lower in 
temperature than the middle or upper. In some of 
the biting days of winter it becomes so cold as to 
make the feet and legs of an adult uncomfortable, 
and completely to chill a child, w r ho, in creeping, 
has his whole body in it for long periods. There- 
fore, should a child be delicate, should he have 
either bronchitis or catarrh of the digestive tract, 
should the weather be very cold, or should the 
heating of the chamber be imperfect, it is better to 



EXERCISE AND AMUSEMENTS. II3 

keep him off the floor and let him take his exercise 
on the nurse's bed, which may be stripped down to 
the mattress for the purpose. Colds are contracted 
and many more are protracted by playing on the 
floor in winter. 

Many nurses, and some mothers, have an idea 
that a child should walk at a certain fixed age, and 
when this time arrives, put into practice various 
plans for teaching the process. Beware of this, for 
go-carts, leading-strings, baby -jumpers and all con- 
trivances of this ilk have a tendency to flatten the 
chest, distort the spine or deform the legs. The 
proper and only safe plan is to let the child teach 
himself to walk. This he readily does, first through 
the act of creeping, in which he exercises every 
muscle of the body without throwing undue weight 
upon the soft bones. When by this exercise he has 
sufficiently strengthened the muscles, he will in- 
stinctively seek to do more ; first in an effort to get 
upon the feet, in which, though failure occurs over 
and over again, he perseveres until successful in 
standing with support, then without, and finally 
ends in walking. 

The first acquisition of the power of walking 
should not be over-taxed, and for a month or more 
the carriage is the best means of airing ; but so 
soon as sufficient strength is acquired for active 
exercise — a somewhat variable age — the child 



114 HYGIENE OF THE NURSERY. 

should walk out and pass as much time as the 
weather and nursery requirements permit, in the 
open air. Set walks, however, are an abomination 
to the child as well as to the adult. City-bred 
children suffer most in this respect, as they are too 
frequently sent out merely to walk a certain number 
of blocks, or for a fixed time, and it is no wonder 
that they quickly tire of such exercise and prefer 
their nurseries to the streets. The only way to 
avoid this is to give an object to the outing, as, for 
example, a household errand or the purchase of a 
cheap toy. In the country, on the other hand, 
children run about and amuse themselves according 
to their own pleasure, visit the garden or the farm, 
and involuntarily take that kind and degree of 
exercise best calculated to promote the growth and 
development of their bodies. 

Delicate, scrofulous and consumptive children 
preeminently require pure air and an out-door life, 
though many of them are too feeble to take suffi- 
cient exercise on foot. For such, when the parents' 
purse allows, a donkey or a pony should be pro- 
vided. Driving may give sufficient exercise at 
first; but so soon as enough strength is gained, 
riding is to be preferred, as it keeps the mind more 
healthfully occupied, strengthens the muscles, ex- 
pands the chest and produces a healthy appetite 
and digestion. 



EXERCISE AND AMUSEMENTS. I I 5 

In the earlier years of life the girl and boy play 
together and take nearly the same sort and amount 
of exercise. As time goes on, however, and the 
girl approaches nearer and nearer to maidenhood, 
she too frequently begins to look upon her brother's 
game of ball or romping play as too rough, and 
spends a constantly increasing time indoors acquir- 
ing the manners and the sedentary habits of her 
elders of the same sex. 

This tendency is often encouraged by parents, 
who prefer polished manners to physical strength, 
and, above all, dislike their daughters becoming 
"tom-boys." One must admit that polished 
manners are a great attraction ; but as a woman has 
more important duties than shining in a drawing- 
room, they are of little intrinsic value when un- 
combined with the fine carriage and good figure 
which belong only to robust health. 

In regard to the carriage and figure, it is useless 
to try to assist their formation by the aid of braces 
and corsets. The latter are especially to be con- 
demned. Unless most cautiously used, they induce 
undue contraction of the lower part of the chest 
and displace the solid organs (liver especially) of 
the abdomen, interfering primarily with respiration 
and digestion, and secondarily with the general 
processes of nutrition. An erect carriage can be 
better secured by attention to the general health ; 



Il6 HYGIENE OF THE NURSERY. 

suitable diet; regulation of the bowels; cold bathing 
and sponging, and exercise short of fatigue, not of 
particular muscles only, but of the whole frame. 

My advice, therefore, is to let the girls join in the 
boys' play. By this plan the latter gain, because 
they are naturally forced to be more gentle, and the 
former, because their rapidly-developing frames get 
the requisite amount of exercise. It is well, how- 
ever, to curb the ambition of the girls to equal the 
athletic powers of the boys, for their muscular 
strength is less. Without letting the subjects know, 
keep a strict lookout upon the general morals, for 
it is absurd to shut one's eyes to this risk in 
mingling the sexes in later childhood and youth. 

Amusements. — A child's life must be devoted to 
the cultivation of his mind and his body, an undue 
development of either resulting in an incomplete 
manhood or womanhood. 

After writing the above sentence I was called 
from my desk to the bedside of a little sufferer, and 
on my w r ay met two boys, both about nine years of 
age, and both patients of mine. The first had a 
spirituelle face, and spoke to me with a tip of the 
hat and the grace of a little Chesterfield; but his 
features were pinched, so it seemed to me, while 
his face was anxious and his legs were hardly thick 
enough to carry his body. Nevertheless, his arms 
were full of books, which, as I had curiosity enough 



EXERCISE AND AMUSEMENTS. 117 

to examine, I found to be a Greek grammar, Caesar 
and the elements of algebra. I felt sorry for the 
overtaxed little brain, and he showed no symptoms 
of joy at release from school, for he was on his 
way home to study all his books, to get the teach- 
er's approval and a high mark on the morrow. 
Scarcely a block away I met my next little friend ; 
his cheeks were rosy, his arms and legs sturdy, 
and his eyes brimful of health and fun. The bur- 
den of books he bore was light, and his teacher 
probably considered him stupid ; but his simple 
" Halloo, Doctor, I am off for a game of ball this 
afternoon," and his jolly smile, were more pleasing 
than all the learning of the first little gentleman. 

The lesson taught by these two children is very 
plain to my mind, and the question which will come 
out ahead in the long run is easily answered ; for 
health has no handicap in the race of life. 

It is right, of course, to let the children study — 
after the sixth year; but the brain is not to be cul- 
tivated at the expense of the body ; in other words, 
our boys and girls must have plenty of play. 

The subject of childish diversion is a broad one, 
and it is only possible to outline it here. Let the 
healthy child play as much as possible in the open 
air, and let him be as active as he pleases ; for his 
own sensations will tell him when to stop and when 
to begin again. The only cautions are not to over- 



I 1 8 HYGIENE OF THE NURSERY. 

look him too much ; to let him make as much noise 
as he wishes out of doors and in his own kingdom 
— the nursery; to make him play those games 
which will exercise all the muscles of the body 
equally, and to guard him, when heated, from drink- 
ing ice water or from lying on the cold, damp 
ground or sitting in a draught. It must be remem- 
bered, also, that play is the child's business, so that 
during convalescence from a debilitating disease it 
must be regulated according to the strength. 

Before closing this chapter a protest must be 
entered against roller-skates and bicycles ; the first 
are dangerous to life and limb, and the last, though 
not so liable to result in broken limbs, produce, 
from the position it is necessary to assume, a narrow- 
ing of the upper portion of the chest. 



SLEEP. 119 



CHAPTER VI. 

SLEEP. 

For some time after birth infants spend the inter- 
vals between being fed, washed and dressed, in 
sleep, and thus pass fully eighteen out of the twenty- 
four hours. As age advances, the amount of sleep 
required becomes less, until at two years thirteen 
hours, and at three years eleven hours, are enough. 
The amount of sleep required will, however, vary 
considerably in different children, but an observant 
mother can soon determine this question for herself. 

Any marked diminution in the average duration 
of sleep, or any decided restlessness indicate dis- 
ease, and demand attention from the physician. At 
the same time, sleep, perhaps more than any other 
item of nursery regimen, is a matter of training, 
and many a mother, by want of judicious firmness, 
has rendered the early years of her child's life not 
only a burden to himself, but an annoyance to the 
entire household. 

One cannot too soon begin to form the good 
habit of regularity in sleeping hours, and so far as 
circumstances admit, the following rules may be 
enforced : — 



120 HYGIENE OF THE NURSERY. 

From birth to the end of the sixth or eighth 
month the infant must sleep from 1 1 p.m. to 5 a.m., 
and as many hours during the day as nature 
demands and the exigencies of the nursery permit. 
This does not mean that the baby is not to be put 
to bed until nearly midnight ; on the contrary, he 
should practically settle for the night at six or seven 
o'clock, but the last feeding should be at eleven 
o'clock. After this he must rest undisturbed until 
the early morning hour, when he should be fed and 
sleep again. 

From eight months to the end of two and a half 
years, a morning nap should be taken, say from 12 
m. to 1.30 or 2 p.m., the child being undressed and 
put to bed. Occasionally an afternoon nap for half 
an hour or more seems necessary, though, as a rule, 
sleep at night is more undisturbed and refreshing 
if this be omitted. The night's rest must begin at 
7 p.m. If a late meal be required, the child can be 
taken up at about ten o'clock, but if past the age 
for this, he may sleep undisturbed until he wakes 
of his own accord, some time between 6 and 8 a.m. 
So soon as thoroughly awake the child must be 
taken up, washed and dressed, and given breakfast. 
This is the only way to cultivate the habit of early 
rising, which promotes both bodily and mental wel- 
fare, and of all habits is the most conducive to a 
long and healthy life. 



SLEEP. 121 

By early rising it is not meant that the child shall 
be roused from a sound sleep by a rough voice or 
hand at a certain fixed hour in winter and an ear- 
lier one in summer, simply for the whim of a fad- 
ridden and over-prompt parent. Quite the reverse. 
Let the child wake of his own accord, for he will do 
so — whether it be late or early — after he has had 
enough sleep; and, if he must get up at a certain 
hour — and never fix it before 7 a.m. — make the 
rousing process as gentle and gradual as possible. 
Sudden rousing excites the brain, quickens the pul- 
sation of the heart, and, if repeated, may lead to 
serious consequences. 

From two and a half to four years, an hour's 
sleep may or may not be taken in the morning, 
according to the disposition and needs of the sub- 
ject, but a child should invariably be put to bed at 
seven in the evening and not be permitted to rise 
until six or seven o'clock on the following morn- 
ing. 

After the fourth or fifth years, few children will 
sleep in the daytime ; they are ready for bed by 8 
p.m., and must be allowed to sleep for ten hours or 
more. 

A later retiring hour than 9 p.m. ought never to 
be encouraged until after the twelfth or fifteenth 
year. Any postponement of the usual hour for 
going to bed is injurious, and should abridgment 



122 HYGIENE OF THE NURSERY. 

of sleep be accompanied by the excitement of a 
child's party or the like the rest obtained is broken 
and productive of a pale face and nerveless frame 
on the succeeding day. 

The position and general features of the night 
nursery have already been described, and it only 
remains to say that when occupied by day it must 
be darkened so as to favor sound sleeping. 

The bed (and where there are several children 
in the family each should have its own) must be 
so situated in the room as to be out of the way of 
draughts. Curtains, while they protect, prevent 
the access of fresh air, and it is far better to ward 
off a draught by a movable, folding screen. 

The form of bed known as a " crib " may be 
occupied until the sixth year. The sides must be 
high, to prevent the child from falling out and in- 
juring himself, and the movable side should work 
upon hinges rather than move up and down in 
slots. 

Springs and a soft horsehair mattress, protected 
by a gum cloth, placed beneath a double sheet, 
under ordinary circumstances constitute the bed 
proper. Sometimes a feather mattress is admissi- 
ble, but this is only when the child is feeble, and 
requires artificial aid to keep up the normal body- 
heat during sleep. 

The objection to feathers is, that the body, sink- 



SLEEP. 123 

ing deeply in, is so completely enveloped that it is 
subjected to an undue degree of heat, which relaxes 
and weakens the system and renders it very sus- 
ceptible to the injurious influences of cold. 

The bed-covering is composed of a sheet, one or 
more blankets — according to the weather — and a 
spread. These must be warm enough to maintain 
a healthy temperature, but, at the same time, not 
so heavy as to oppress the child. 

Especial care should be taken not to cover the 
nose or mouth, and it is much better to keep the 
air of the nursery at a proper, even temperature by 
an open fire than to secure warmth to the body 
alone by weighty bed-coverings. 

The pillow ought to be small, rather thin than 
the reverse, and made, except for very young in- 
fants, of soft horsehair. 

A bed should never be made up directly upon 
the child's leaving it, for then it is saturated with the 
nocturnal exhalations from the body. So soon as 
vacated, the bed-coverings must be thrown over the 
backs of chairs, the mattress shaken up, and, the 
windows of the chamber being thrown open, allowed 
to air for an hour or more. 

In the matter of bed-clothing, cleanliness is as 
important as in body-clothing, and the nurse must 
never neglect to re-make a bed if the sheets become 
wet with urine or otherwise soiled, no matter at 



124 HYGIENE OF THE NURSERY. 

what hour of the night the accident may occur. 
Much trouble in this direction may be avoided, 
however, by regularly taking up the child at the 
time of the last feeding and encouraging a thorough 
evacuation of the bladder. 

Children should never sleep in the same room 
with persons who are ill, whether the disease be 
acute or chronic. Sleeping with those having a 
long-standing cough or consumption of the lungs 
is especially to be avoided. Do not get the baby 
into the habit of being rocked or walked to sleep, 
and do not allojv older children to sleep too soon 
after a meal, as the processes of digestion are apt 
to produce restlessness and uneasiness. Again, a 
bright light or conversation in the bedroom should 
never be permitted after the children have settled 
to rest. 

Finally, teach the nurse to make up the bed 
neatly and smoothly, and direct her to turn the pil- 
low and smooth out the sheets, should her charge 
be restless at night. By this latter procedure sound 
sleep is often brought to a fretful child. 



BATHING. 125 



CHAPTER VII. 

BATHING. 

A well-known English writer states, that " water 
to the body — to the whole body — is a necessity of 
life, of health, and of happiness ; it wards off dis- 
ease, it braces the nerves, it hardens the frame, it is 
the finest tonic in the world." 

On the word "tonic" the whole subject hinges. 
Every one knows that food, even in such a simple 
form as milk, may be given to excess, with the pro- 
duction of illness, and that medicines are yet more 
easily abused. Why, then, if the bath be a tonic 
agent, may it not be often used injudiciously and 
to the detriment of the child ? 

Intelligent nurses who have grown gray in ser- 
vice, often say they have seen babies " washed into 
heaven." This act has never been actually accom- 
plished in my experience, but it has been often 
enough approached to justify introducing this chap- 
ter with the caution that, should the infant be ailing, 
the bath had better be discontinued until the phy- 
sician can be consulted. This, of course, does not 
preclude ordinary cleanliness, for every part of the 



126 HYGIENE OF THE NURSERY. 

child's body liable to become soiled can be readily 
cleaned by the use of a moist sponge, with or 
without soap, and without bringing into play any 
of the medicinal or, in other w r ords, tonic effects of 
the bath. 

The initial bath is to be given as soon after birth 
as the nurse, having made the mother comfortable, 
can turn her attention to the child. This bath 
differs somewhat from those that succeed it during 
infancy, in the fact that it involves a special pro- 
cedure, namely, the removal of the tenacious, 
paste-like material which usually adheres to the 
skin of the newly-born. 

This substance, the veniix caseosa, is a fatty var- 
nish or deposit secreted by the glands of the skin. 
While the foetus is in the womb, it probably acts as 
a protecting agent, but if allowed to remain long 
after delivery, it becomes dry and hard, and, in 
addition to impeding the healthy activity of the 
skin, leads to excoriations or various eruptions. 

To remove it, first rub the whole surface gently, 
though thoroughly, with a bit of flannel covered 
with fresh lard or olive oil; next, wash off the soft- 
ened and greasy coating with a sponge saturated 
with warm water and soap, and finally, complete 
the bath by immersing the body in warm water for 
one or two minutes. 

After this preliminary cleansing, one bath a day 



BATHING. 127 

should be the rule until the completion of the third 
year of life. 

The monthly nurse must bathe the child while 
she remains in attendance ; afterward the mother is 
the proper person, unless the nurse-maid be excep- 
tionally careful and experienced ; and even in this 
event the mother should superintend the process. 

A tub with a supply of water, a piece of soft 
flannel for a wash rag, a fine sponge, a bit of good 




bath table, a, a, elastic tapes for steadying tub. 

soap and several soft towels are the necessary arti- 
cles. A long apron made of soft flannel is also useful, 
and it is well to provide a low chair and a bit of 
oilcloth to place on the floor underneath the tub. 
The former enables the bather to get more on a 
level with her work and make a deeper lap for the 
child to rest in, and the latter receives any water 
that may be splashed about. A stand is now made 
to hold the baby's bath tub, Fig. 15, and is so con- 



128 HYGIENE OF THE NURSERY. 

trived that it can be folded up and laid away when 
not in use. It is convenient, inasmuch as it obviates 
the necessity of stooping over, by bringing the child 
more on a level with the bather. It has straps and 
hooks attached to the sides to hold the tub firmly 
in place while in use.^ 

An ordinary, oblong tin tub, painted white inside 
and large enough to give plenty of room, is to be 
preferred to either a porcelain basin or a wooden 
tub. When in use, the tub should be placed on the 
floor, for the sake of firm support, or on the bath 
table, and afterward must be well cleaned, dried 
and aired. 

Water for the bath ought to be pure and soft, and 
should it be muddy or otherwise foul, the nurse 
must take the trouble to filter it. The character of 
softness is an important one, and when it is impos- 
sible to obtain anything but hard water from the 
ordinary sources of supply, a special provision 
ought to be made for the collection of rain water. 
The quantity used at a time should be sufficient to 
cover the child up to the neck when placed in the 
tub in a semi-reclining position. 

A matter of great importance is the temperature 
of the water. Some — fortunately very few — people 
use cold water from the first, under the impression 
that it is strengthening. So far from this being the 
case, cold water, instead of " hardening," depresses 



BATHING. 129 

the vital forces and frequently produces inflamma- 
tion of the eyes, nasal catarrh and inflammation of 
the lungs and bowels. 

While cold baths are not to be recommended, 
one must not go to the other extreme, and use too 
hot water; for this also weakens the frame and 
renders it more susceptible to the attack of 
disease. 

Ninety-five degrees Fahrenheit in winter, and 
from eighty-five to ninety-two degrees in summer 
are the proper temperatures. As the heat of water 
cannot be estimated by the hand with any degree 
of accuracy, it is essential to use a bath thermom- 
eter. See Fig. 16. 

Place this instrument in the water and allow it 
to remain a few moments, so as to get a full effect 
upon the mercury. Should the water be too hot, 
it may be readily cooled by the addition of cold 
water, or, if too low in temperature, as easily raised 
to the proper degree by pouring in hot water. 

It is impossible to insist too strongly upon the 
necessity of uniformly using the bath thermometer. 
Several times in my experience a tin bath tub has 
been filled with water so hot that its sides burned 
the delicate skin of the little hand placed upon 
it; fortunately, in such instances, the consequent 
screams led to careful investigation, and no seri- 
ous damage resulted. On the other hand, I have 
9 



13° 



HYGIENE OF THE NURSERY. 



Fig. 16. 



felt the water cold enough to pain the 
fingers. Don't neglect the thermome- 
ter, then ! 

A piece of flannel is very useful for 
the first part of the bathing. It readily 
takes soap, and, being soft, can be 
thoroughly rubbed over the skin without 
danger of injury. A large, soft sponge, 
however, is best suited to the finishing of 
the bath, for it holds more water than a 
flannel wash rag, and enables the bather 
to stream the water over the child's 
body, and thus get the stimulating effect 
of a miniature shower bath at the same 
time that the dirt and superfluous soap 
are washed away from the surface. The 
wash rag and sponge must, by the way, 
be the child's exclusive property, and 
are not to be used twice in succession 
without being thoroughly cleaned and 
dried in the open air. 

Unscented Castile or glycerine soaps 
are the best to use. Common soaps are 
irritating to the skin, and even the purest 
and most bland articles must be em- 
ployed with care; that is, neither too 
frequently nor too profusely, lest they 
lead to eczema or other cutaneous disorders. When 



jfeH 




I ATH 
l HBKMOMBTBR 



BATHING. 131 

any skin disease is present, the physician's advice 
must be had not only as to the use of soap, but 
also in reference to the propriety of the bath 
itself. 

Two towels are required for each bath. These 
should be large and composed of fine, soft material. 
They must be dry and warm, and perfectly 
clean before they are applied to the surface of the 
child. 

The bath apron should be made of two pieces of 
soft, white flannel ; one long enough to extend from 
the waist almost to the feet of the bather, and broad 
enough to completely cover the front of her gown ; 
the other quite as broad but about four inches 
shorter. Both pieces are sewed to a waist belt, 
forming, in reality, two aprons ; the upper of which 
is thrown over the shoulder when the infant is being 
lifted from the tub, and then used as a dry and 
warm covering when he reaches the lap. After the 
bath, the apron, being more or less wet, must be 
taken off and thoroughly dried. Several such arti- 
cles should be provided, as they must be frequently 
washed to keep them clean and free from odors. 

Any low chair will do to use in bathing, though 
as those usually sold in the shops have not a suf- 
ficiently broad seat to give a comfortable support, 
it is better to make one by sawing off the legs of an 
ordinary wooden kitchen chair. 



132 HYGIENE OF THE NURSERY. 

The bath must be given at a regular time each 
day. The best hours are in the morning, midway 
between two feedings, at ten o'clock, for instance; 
and in the evening, just before the infant gets his 
last bottle and goes to bed. The first is perhaps the 
better hour, but regularity is the more important 
point. 

At the time selected, place the tub containing the 
water, heated to a proper temperature, in a warm 
and sheltered part of the room, and around it ar- 
range, within convenient reach of the hand, the 
various requisites of the bath. 

Upon undressing the child, wet his head first; 
then let the head and shoulders rest on the left 
forearm and lower the child gently into the 
water, that his body may be covered as far as his 
neck. Take a wetted and sponged flannel wash 
rag in the right hand, and pass it rapidly but thor- 
oughly over the body, avoiding the eyes. Pay 
particular attention to the arm-pits, to the region 
between the folds of the buttocks and to the groins. 
This done, take a large, well-filled sponge in the 
right hand and squeeze the contents over the body. 
The chief force of this miniature douche must fall 
upon the back and loins, and the child, during the 
operation, must be lifted clear of the bath-water by 
the left arm and hand. 

The sponge is used simply to clear off the dirt 



BATHING. 133 

loosened by the wash rag, and to remove all super- 
fluous soap; therefore, so soon as this is accom- 
plished, the child should be lifted from the tub to 
the lap and enveloped in a towel, or better still in 
the loose folds of the bathing apron. The drying 
process now begins and consists in absorbing the 
moisture from the skin. This is done by a series 
of very gentle patting movements with a towel 
folded over the palm of the hand. In drying a 
baby, especial attention must be given to those 
portions of the body where the natural folds form 
crevices in which water may lodge. Unless these 
parts be thoroughly dried, serious consequences 
may ensue. If it be retained in a normal crevice — 
the fold of the buttocks or behind the ears — it 
causes in a short time troublesome excoriation. 

" Never allow anything smaller than the elbow to 
enter the ear," is excellent advice; though, during 
the bath should water get in and be allowed to 
remain, it may lead to ear-ache and abscesses, and 
in extreme, though not rare, cases, to deafness. 
In the event of this a blunt cone formed out of a 
soft handkerchief will quickly absorb the moisture, 
and will do no harm if inserted but a very short 
distance within the orifice. 

The nose can readily be cleaned by the soft cone- 
shaped handkerchief, especially if a little vaseline 
be added to facilitate the process. 



134 HYGIENE OF THE NURSERY. 

After the infant is patted perfectly dry — not rudely 
rubbed with a towel — the whole surface, but 
especially the region on each side of the spine, 
should be rubbed with the naked palm until the 
skin becomes slightly red. This modified massage 
ends the bath, and the child must then be dressed 
as quickly as possible. 

Several important points yet remain to be men- 
tioned. Never give a bath immediately after a 
meal nor when the child is either cold or over- 
heated. Never suddenly or rudely plunge the 
body into the water, and never allow the time of 
actual immersion to exceed five minutes. Under 
no circumstances should the head and face be 
allowed to dip beneath the surface. Should this 
happen, the child will become so frightened that 
it will be difficult to get him to enter the water 
again ; and here, by the way, it may be well to 
state that if there be repugnance to the bath, the 
tub may be covered over with a blanket, and the 
child being placed upon it, may be slowly lowered 
into the water without seeing anything to excite 
his fears. 

The question of the propriety of using powder 
after a bath is often asked by mothers. Powdering 
has always seemed to me to be a lazy way of 
absorbing moisture that should be taken up by a 
dry towel, and unless there be some excoriation or 



BATHING. 135 

other indication for its use, the skin can be kept 
cleaner and healthier without it. In cases, too, in 
which some disorder of the skin would seem to 
warrant its employment, better and quicker results 
are ordinarily obtained by the application of cold 
cream, oxide of zinc ointment or vaseline. 

The rule of one bath a day may be exceeded in 
very hot weather, when, in addition to the morning 
full bath, the body maybe sponged twice daily with 
water at a temperature of 90 F. This, contrary 
to what might be expected, has a greater and more 
permanently cooling effect than bathing with cold 
water. 

From what has been written, one might suppose 
that the details of an infant's bath are endless ; so 
they must seem when given in full. A skillful 
bather, however, ought to fulfill every requisite and 
complete the bath in a period of time not exceeding 
twenty minutes at the very outside, and this must 
include not only the actual five minutes' immersion, 
but the preparation of the bath and the drying 
process. 

After the third year three full baths a week are 
quite sufficient. An evening hour is now to be 
preferred, but the water must still be heated to 90 
F. in winter, though it may be cooler in the heat 
of summer. While, at this age, the child has his 
three full baths weekly, for the purpose of securing 



I36 HYGIENE OF THE NURSERY. 

absolute cleanliness, he must be sponged everyday 
with water, cool or warmed according to the season. 

The sponge bath is best given in the morning, 
soon after the child has roused himself from sleep 
and before any food is given. The nurse, for this, 
must provide herself with a large basin containing 
water at a temperature of 75 ° in summer and 85 ° 
in winter, a large, fine sponge and several towels. 
The bath-apron being donned and the child's night- 
clothes removed, the sponge filled with water is 
passed rapidly over the whole surface of the body ; 
then the child must be wrapped up in the apron 
and the skin first dried gently with a soft towel and 
then rubbed into redness with the open hand. 
When this process is completed — and it should be 
done in at least ten minutes — the clothing is put on 
rapidly, and the child is ready and usually hungry 
for his morning meal. No soap need be used in 
these baths. 

In the tri-weekly cleansing bath the process of 
washing is much the same as in infancy. That is, the 
bath tub being filled with water at a temperature of 
about 90 , the child is put into it up to his neck and 
thoroughly soaped with a wash rag, and next 
douched clean with a large sponge. Here, also, 
the head must be wet first; the body immersion 
must not last longer than five minutes, and the dry- 
ing must be done quickly and with a patting rather 



BATHING. 137 

than a rubbing movement. Ample reaction of the 
skin must be secured by gently rubbing with the 
palm of the hand, especially over the spine. 

The washing of the head is a most important 
matter, as it cleanses the scalp and prevents the 
formation of scurf, and adds beauty to the hair. At 
the same time the nurse must be careful how she 
dries the hair. To rub it gently with a soft towel 
and then brush it out with a fine hair brush is the 
proper plan. Combing, in so far as it means dress- 
ing the hair and cleansing the scalp with a fine 
comb, must never be allowed, as it not only thins 
the hair by pulling it out by the roots, but also 
irritates the scalp and produces eruptions upon it. 

As the child approaches puberty he must gradu- 
ally be taught to wash himself, and should be 
encouraged to form the habit of bathing every day. 
The bath at this age should be a sponging rather 
than a soaking process ; it is best taken in the 
morning directly after rising, and the temperature 
of the water may range from 65 ° to 75 °, though 
delicate children may require it warmer, especially 
during winter weather. 

When childhood merges into youth, while the 
sponge is still preferable to the plunge, water may 
be used, all the year round, just as it flows from the 
faucet. The temperature will be, of course, quite 
low at times, but so long as the bath is taken in a 



I38 HYGIENE OF THE NURSERY. 

warm room, completed quickly, and followed by a 
sense of stimulation and warmth, nothing but good 
results. 

Whatever room be used for the purpose of the 
toilet, the child, if he be old enough to bathe him- 
self, should occupy it alone, so that the whole body 
may be stripped naked ; otherwise washing cannot 
be thoroughly or effectually accomplished. The 
paraphernalia required are : a large basin, a tin 
chamber tub or the ordinary fixed bath tub; a 
piece of coarse flannel, one yard long and half a 
yard wide ; a large sponge ; a tablet of soap ; a soft 
towel and a Turkish bath-towel. 

Having drawn a sufficient quantity of water — 
two-thirds of the basinful, or two or three inches 
in either of the tubs — the successive steps of the 
bath are as follows : Wash the hands with soap ; 
dip the head and face into the water ; re-soap the 
hands and rub and wash the head, face, neck, chest, 
and arm-pits ; take the wetted sponge and go all 
over the parts previously covered by the soaped 
hands ; fold the flannel into a long band, dip it into 
the water, and, holding an end in either hand, throw 
it over the shoulders, and move it several times 
from side to side, then up and down, and then across 
the back and loins ; dip the sponge into water again, 
and holding the head and shoulders over the tub, 
stream the water once or twice over the head, neck 



BATHING. 139 

and face ; step into the bath, re-soap the hands and 
pass them quickly up and down the legs and over 
the feet. Fill the sponge and squeeze its contents 
over each leg ; finally, sit down and with soaped 
hands wash the region between the buttocks, 
removing the suds by a few splashes of water. 
Next, step from the tub and dry the body quickly, 
taking care to remove all the moisture from the 
ears, from between the toes and from the different 
folds of the body. The drying is to be accomplished 
by brisk rubbing, first with the soft towel and then 
with the Turkish towel. The back and loins are the 
most difficult to reach, but if the towel be thrown 
over the shoulders, as one would a skipping rope, 
and moved from side to side several times, the dry- 
ing of these parts is accomplished without trouble. 

A boy should wash his head as above described 
each morning ; a girl, who has long hair, at least 
once a week. 

Any loitering over the bath is attended with the 
danger of chilling. Never occupy more time than 
fifteen minutes in the whole process. 

These daily sponge baths are ordinarily quite 
sufficient to keep the person perfectly clean ; some- 
times, however, it is necessary to take, in addition, 
a full, warm bath at intervals of a week. These 
baths are relaxing if too prolonged; ten minutes is 
the maximum time for remaining in the water. 



I40 HYGIENE OF THE NURSERY. 

After leaving the tub there must be no exposure to 
draughts. The best hour for such a bath is in the 
evening; some time after the last meal and just 
before going to bed. 

Sea-water baths are useful for a child of any age, 
although ordinary sea bathing is not to be recom- 
mended until the child is old enough and strong 
enough to hold his own in a moderate surf — after 
the eighth year, for instance. A younger subject 
may, when at the seaside, be dressed daily in a 
bathing suit and allowed to splash for a time at the 
edge of the surf. The process of carrying a child 
against his will into the waves and immersing his 
head, as is often done, is cruel and productive of so 
much terror that more harm than good results. 

In our climate, the proper season for sea bathing 
is from the middle of June until the middle of 
September. 

On arriving at the coast, it is always well to pre- 
pare for the plunge in the sea by giving, on the 
first day, a warm salt-water bath. On the day 
following, about three hours after breakfast, the 
child may don his bathing dress. Immediately on 
entering the water, the head must be thoroughly 
wetted. After this, the bath may be protracted for 
fifteen, or at most twenty, minutes. To get the 
invigorating effects of a surf bath, it should never 
be repeated oftener than once a day, and in some 



BATHING. 141 

cases it is better to allow a day to intervene, or 
even to enter the water only twice a week. Drying 
and dressing should be rapidly performed, and a 
half-hour's brisk walk is very useful in promoting 
reaction and causing free circulation of the blood. 
Should the bather feel faint after coming out of the 
water, he must be wrapped in towels and given half 
a tumblerful of milk containing one or more tea- 
spoonfuls of brandy or whisky. 

When the child is either cold or perspiring freely, 
the bath must not be undertaken. 

The bathing suit should be of light flannel, made 
in one piece like a pair of moderately loose night 
drawers, but with short arms and legs; it should 
open only over the shoulders, where, when put on, 
it is fastened by buttons. This arrangement permits 
of easy removal after the bath when the flannel is 
saturated with sea water, and is, in consequence, 
heavy and sticky. 

The question of sea bathing suggests that of 
swimming. Boys, and girls also, should learn to 
swim early. The art is not only a safeguard, but a 
means of most pleasant and invigorating exercise. 
It develops the muscles, expands the chest, aids 
digestion, strengthens the whole frame, and pro- 
motes energy, courage and self-reliance. 

Swimming, like every other exercise, must be 
taken in moderation. Even with this care it is not 



142 HYGIENE OF THE NURSERY. 

always beneficial. The bather should leave the 
water experiencing a pleasant glow over the whole 
surface of the body; the spirits and appetite should 
be increased, and there ought to be a sensation of 
augmented strength. If, on the contrary, it should 
disagree, there is a sense of chilliness, with lassi- 
tude and depression of spirits; the face is pinched 
and pale, and the lips and finger nails are apt to 
look blue. 

Swimming in salt water is more invigorating than 
in fresh. Apart from the different quality of the 
two waters, the battling with the waves in the 
former case is more exhilarating, and the sea 
breezes, blowing upon the body, carry with them 
health and strength. Every one must have noticed 
the increased softness and beauty of the skin and 
the greater lustre of the hair after a sojourn at the 
seaside. 

It may be serviceable next briefly to detail the 
different baths in common use as well as those most 
often directed by physicians, with some reference to 
their effects upon the system. 

Concerning temperature, the bath may be: — 

i. Cold, temperature 50 to 65 F. 

2. Cool, " 65 to 75 « 

3. Temperate, " 75 to 85 " 

4. Tepid, " 85 to 92 " 

5. Warm, " 92 to 98 " 

6. Hot, " 98 to 112° " 



BATHING. 143 

When giving a cold bath, strip the child in a warm 
room, and rub him thoroughly with the palm of the 
hand until the whole body, especially the spinal 
region, is warm. Let him then stand in a tub con- 
taining enough hot water to cover the feet, and 
sponge him rapidly with the cold water. The 
temperature of the latter must never be below 6o° 
F., and the addition of half an ounce of rock salt 
or a tablespoonful of concentrated sea water to the 
gallon, renders it more stimulating and insures a 
complete reaction. After sponging, the surface 
must be thoroughly and quickly dried with a soft 
towel and shampooed with the open hand until 
aglow. 

This bath, provided the degree of cold does not 
exceed the resisting powers of the child, is a 
powerful tonic, producing rapid tissue changes and 
increasing nutrition. Should the water be too 
cold, or the sponging continued too long, reaction 
does not follow the primary shock, and the result is 
fatigue, exhaustion, or even dangerous prostration. 
This bath, therefore, must be used with caution and 
only under a physician's advice. The cases in which 
it is of most service are those in which there is a 
sluggish circulation with poor appetite and feeble 
digestion ; in which the nutrition is impaired, as in 
rickets, and in certain spasmodic nervous disorders. 

A cooled bath is sometimes prescribed, and may 



144 HYGIENE OF THE NURSERY. 

be employed with advantage in conditions attended 
with very high fever. The child is first immersed 
in water at 95 °, and this is gradually lowered to yo° 
by the addition of cold water, the process occupy- 
ing from fifteen to thirty minutes. 

Analogous to this bath is the cold pack. Fold a 
sheet in such a way as to be long enough to extend 
from the child's arm-pits to his feet, and wide enough 
to encircle completely his body ; dip it in water at 
8o° and lay it smoothly upon a cot, the mattress of 
which must be protected by a rubber Mackintosh. 
When all is in readiness, place the child upon the 
sheet, and wrap it around his body and legs. A 
blanket must then be thrown over the sheet and 
the pack left undisturbed for ten minutes. Then 
lift the child out quickly and envelop him in a warm 
blanket and allow him to remain at rest for some 
little time. 

In the absence of the physician, sponging with 
water, at a temperature of jo° or 8o°, is the only 
safe bath to employ to reduce temperature. In 
giving this bath, strip the child and place him in 
bed between blankets, while the nurse, inserting her 
hand between, must pass a damp sponge slowly 
over the surface. Five to ten minutes may be con- 
sumed in this operation, though, if the child com- 
plain of chilliness, discontinue the sponging at once ; 
a sensation of cold, too, indicates the use of warmer 



BATHING. 145 

water. The operation may be repeated several times 
daily, or as often as every two hours in urgent cases, 
and when the heat reduction is of short duration. 

The hot bath, 95 to ioo°, is employed for vari- 
ous purposes — to relieve nervous irritability, to 
promote sleep, to produce sweating, and to draw 
the blood to the surface in the event of congestion 
of some internal organ. Whether a full bath or 
merely a foot bath be required, five minutes is suf- 
ficient time for immersion ; then, with or without 
drying, according to the degree of sweating desired, 
the whole body, or only the feet and legs in case 
of a foot bath, must be enveloped in a blanket, and 
the child put to bed. To render these baths more 
stimulating, a teaspoonful to a tablespoonful of mus- 
tard flour may be added, and the child held in the 
water until the arms of the nurse begin to tingle. 
The hot bath is purely stimulating, and it is import- 
ant not to continue it too long, lest the primary and 
only desirable effect be followed by depression. 

The blanket bath is useful in producing perspira- 
tion. Wring a blanket out of hot water and wrap 
it around the child ; then throw three or four dry 
blankets over him and leave him for half an hour; 
rub the body then with a soft towel, to absorb the 
moisture thoroughly, and keep the child in bed. 

There are several medicated baths in frequent 

domestic use, which it may be useful to describe. 
10 



I46 HYGIENE OF THE NURSERY. 

Mustard Bath. — Take from two teaspoonfuls to 
two tablespoonfuls of mustard flour ; hot water, two 
to four gallons. 

In form of foot bath it produces sweating and 
determines the blood to the surface. As a general 
bath it acts as a powerful stimulant. 

Salt-water Bath. — Take four tablespoonfuls of 
rock salt, or Ditman's sea salt, or concentrated sea 
water ; water, hot or cool, according to season, four 
gallons. 

To be used as a general bath every morning in 
chronic tuberculosis, scrofula, rickets, and general 
debility. Bath to be followed by thorough rubbing 
of the surface, especially over the spine. 

Bran Bath. — Take one pint of bran ; tie up in a 
muslin bag, place in a quart of water, boil for an 
hour, squeeze bag thoroughly into the water, and 
add to four gallons of warm water. 

Useful in eczema and other skin diseases. 

Soda Bath. — Take one tablespoonful of bicar- 
bonate of sodium; warm water, four gallons. 

Used in skin affections. 

Compresses are often useful. The wet com- 
press consists simply of a roll of flannel or soft 
linen dipped in cold water and wrung out, and then 
applied to the part indicated. Cover this with 
a piece of oiled silk rather larger than the com- 
press. 



BATHING. 147 

There are several matters that bear a more or 
less close relation to the subject of bathing. These 
are the care of the teeth, nails and hair. 

The teeth must be cleaned morning and evening, 
and the cleansing process must be begun with the 
appearance of the first tooth. Ordinarily, a soft 
wash rag folded over the forefinger, dipped in cool 
water and thoroughly rubbed over the teeth, is suf- 
ficient to keep the early teeth clean, and does not 
injure the tender gums. Should a dark-colored 
scum form at the junction of the tooth and gum, a 
little prepared chalk or other bland tooth-powder 
may be used in addition. If it be impossible to get 
at the point of discoloration in this way, shape with 
a penknife a moderately hard bit of wood into the 
form shown in Fig. 17, then either bite or rub the 
woody fibres at the extreme end into a sort 
of bunch, wet this, dip it in the tooth-pow- IG ' I7 ' 
der and gently rub at the discoloration until 
it disappears, taking care not to make the 
gum bleed. Over a piece of wood so shaped 
one may also wrap a bit of soft cambric and 
use water and powder as before. 

Take good care of the milk teeth, for if 
they become decayed and broken off or 
lost, their permanent substitutes are apt to 

1 * STICK FOR 

come in irregularly and produce a lasting ^|^ ING 
deformity. 



I48 HYGIENE OF THE NURSERY. 

The tooth brush can be used after a number of 
the milk teeth have been cut. The bristles should 
be very soft and fine, and it must be employed with 
gentleness. Unless there should be some discolor- 
ation, no powder need be used. 

The child should early learn to clean his own 
teeth. 

The importance of taking care of the toe nails 
has already been referred to in the chapter on 
clothing. The finger nails should not be allowed 
to grow too long ; at the same time it is a bad plan 
to cut them close to the quick. In trimming them, 
use a moderately dull pair of scissors, and do not 
round them too much. When hang-nails appear, 
they must be cut close with sharp scissors. The 
fingers and toes should be inspected carefully after 
each bath, to see if they require attention. 

Directions have already been given in regard to 
washing the hair. All that remains to be said now 
is to repeat the caution against the use of a fine 
comb, and to protest against the employment of 
hair-oil and hair-washes. The best scent for the 
hair is an occasional dressing of soap and water ; 
the best beautifier, a thoroughly good brushing 
with good brushes, and the latter should be em- 
ployed every morning and evening. 

Besides keeping the long hair of a girl free from 
scent and grease, do not dress it over the ears or tie 



BATHING. 149 

it up tight and make it " like a cap of iron over the 
skull." 

If the hair be well brushed and the scalp thus 
sufficiently stimulated, there will be enough natural 
oil secreted to keep it tidy ; artificial oily applica- 
tions only act temporarily, and by blocking up the 
pores of the skin tend to make the hair drier and 
harder to keep in order. 

Should there be a tendency for the hair to fall 
out, wash the scalp thoroughly and frequently 
with soap and water, and stimulate it by firm 
brushing and the use of a wash such as the follow- 
ing:— 

Take of— 

Aromatic spirits of ammonia, one fluidounce. 

Tincture of cantharides, . . one and a half fluidrachms. 

Glycerine, half a fluidounce. 

Rose water, , . seven fluidounces. 

Mix. 

A tablespoonful of this may be rubbed into the 
scalp once every day, the rubbing to be followed 
by washing with a sponge and vigorous brushing. 

In such cases, however, it is best to seek the 
advice of a physician, for falling out of the hair may 
be due to a variety of causes. 



I5O HYGIENE OF THE NURSERY. 



CHAPTER VIII. 

FOOD. 

The choice of food and the method of feeding 
bear so close a relation to age that it is necessary, 
in studying these questions, to regard them from 
the standpoint of the two stages of a child's life 
mentioned in the first chapter; that is to say, the 
periods of infancy and childhood. 

Infancy. — An infant may be fed in one of three 
ways: 1st, from the mother's breast; 2d, from the 
breast of a foster mother or wet nurse; and 3d, from 
a bottle, by the method known as artificial or hand- 
feeding. 

1st. Feeding from the maternal breast. There can 
be no doubt that this, being the natural, is at the 
same time the proper method of nourishing the 
human infant; and fortunate is the babe that, in 
our day of advanced civilization and city-living, 
can draw from the breast of a robust mother an 
abundant supply of pure, health-giving, tissue-build- 
ing food. 

It follows, therefore, that every woman who is 
free from certain contra-indicating diseases, to be 
mentioned later, should nourish her child solely 



FOOD. 1 5 I 

from her breast up to the age of eight months, and 
partially to the end of the first year, or, failing in 
either limit, so long as possible. 

The infant should be put to the breast as soon as 
the mother has recovered somewhat from the fatigue 
of labor — some four or eight hours after birth. Of 
course no milk can be drawn at this early date, but 
the babe gets a small quantity of thin, watery fluid, 
called colostrum, which affords sufficient nourish- 
ment, and at the same time, from its laxative prop- 
erties, clears away the greenish or black, viscid 
material that collects in the infant's intestinal canal 
during intra-uterine life. This procedure, too, is of 
great advantage to the mother, for it insures proper 
contraction of the womb, draws out the nipples, and 
encourages the formation of milk. 

As the secretion of milk is never fully established 
until the third day after labor, it stands to reason 
that no food other than the colostrum is required 
before that time. Hence, the practice of filling the 
infant's stomach with gruel, sugar and water, and 
other sweetened mixtures, is more than useless, for 
it diminishes the activity of sucking and the conse- 
quent stimulation of milk production. Put the 
child to the breast every two hours while the 
mother is awake, and there need be no fear of 
starvation. 

After the third day, should the breasts not yield 



152 HYGIENE OF THE NURSERY. 

a supply of milk, a little sound cow's milk diluted 
with double its quantity of water and sweetened 
with sugar of milk, may be given every fourth 
hour, the babe being put to the breast in the 
meanwhile. So soon as the flow begins, however, 
the artificial feeding is to be discontinued. 

Usually on the fourth day milk is secreted and 
regular lactation commences. Many untrained 
mothers make a failure of nursing because they 
know nothing of the manner of giving suck ; of the 
length of time the child should be kept at the 
breast ; of the proper time for, and interval between 
feeding, and of the importance of regularity. Upon 
these points the physician should give minute in- 
structions. 

When giving the breast, the infant must be held 
partly on its side, on the right or left arm, accord- 
ing to the gland about to be drawn, while the 
mother must bend her body forward, so that the 
nipple may fall easily into the child's mouth, and 
steady the breast with the first and second finger of 
the disengaged hand, placed above and below the 
nipple. In case the milk runs too freely — a condi- 
tion very apt to excite vomiting — the flow is easily 
regulated by gentle pressure with the supporting 
fingers. Each of the breasts should be drawn alter- 
nately, the contents of one being usually sufficient 
for a meal ; and a healthy child may be allowed to 






FOOD. 153 

nurse until satisfied, when he will stop of his own 
accord, drop the nipple and fall asleep with milk 
still flowing over his lips. 

During the first six weeks the breast is required 
every second hour, from 5 a.m. until 1 1 p.m. At 
night the infant should be put in a crib by the 
mother's bed, or in an adjoining room, under the 
care of a competent nurse, and there remain quietly 
until the morning feeding. This secures the mother 
six hours of uninterrupted repose, a matter of great 
importance to her general health and consequent 
capacity for prolonged lactation. As to the infant, 
he may rebel at first, and wake and cry, so that it is 
necessary to quiet him with a little milk and. water 
administered from a bottle ; but often after a few 
days, and certainly at the end of a week or two, the 
good custom of sleeping at night is formed, and 
there is no further trouble. 

Regularity in meal hours is even of more import- 
ance in early than in adult life, on account of the 
natural feebleness of digestion. To secure this, it 
is only necessary to have a little perseverance, for 
infants are such creatures of habit that a short train- 
ing brings them into the way of expecting food only 
at certain times, and, when healthy, they wake to 
suck the breast with almost the precision of the 
clock. While insisting upon this rule, one must 
recognize the fact that, although in the vast majority 



I 54 HYGIENE OF THE > 

of instances a two-hours' interval is most suitable 
up to the second month, there is no absolute law as 
to the number of daily nursings. Some infants 
seem to need food less frequently, and it is best to 
respect their peculiarity and not force the breast 
upon them so long as they sleep well, do not fret 
when awake, and thrive generally. Others, again, 
may require it oftener, every hour and a half, per- 
haps, and once or twice at night In these excep- 
tional cases an appropriate schedule can only be 
made by close observation of individual character- 
is: :s. 

A common and most ruinous mistake is to resort 
to constant feeding as a means of pacifying crying. 
Babies certainly do cry from hunger, but just 
frequently the crying results from colic, or from the 
discomfort and pain of indigestion. Every mother 
should be able to recognize the difference. The cry 
from hunger usually begins after a sound sleep. It 

:ot peevish, and stops at the sight of the breast, 
when the infant rouses himself, presents an expres- 
sion of pleasure, clinches his hands and flexes his 
limbs. The cry of colic is violent and paroxysmal ; 
the face is livid and wears an expression of suffer- 
ing ; the abdomen is distended and hard ; the 
hands and feet are cold ; the legs are drawn up or 
kicked violently about : and an explosion of wind 
from the mouth or bowels ends the attack. A 



FOOD. 155 

peevish cry, hot skin and sour breath attend indi- 
gestion. 

It stands without saying that the cry of hunger 
must be relieved by giving food ; but this is the 
very worst thing to do under other circumstances, 
for it both breaks up good habits and produces 
serious mischief. The pain of colic and the discom- 
fort of indigestion are chiefly due to the accumula- 
tion of flatus resulting from the fermentation of food. 
Mothers soon learn, and unfortunately infants too, 
that the breast milk temporarily relieves suffering. 
This it does in the same way as any other warm 
liquid ; but, unlike a simple fluid, milk only adds 
more material to the already fermenting contents of 
the gastro-intestinal canal, and every nursing is 
soon followed by more pain, until between crying 
and sucking and sucking and crying, the infants 
life is passed in misery, if not cut short altogether. 
Instead of continuous feeding, the plan for relief is 
to decrease the quantity of food by increasing the 
intervals between nursing and by abridging the time 
of lying at the breast, while medicines are employed 
to strike at the root of the evil. 

After the sixth week the interval between nurs- 
ings may be slowly increased until, by the fourth 
month, it reaches three hours. During this period, 
also, the time of lying at the breast may be gradu- 
ally lengthened, for the quantity of milk secreted 



I56 HYGIENE OF THE NURSERY. 

and the child's appetite and capacity for food are 
all augmented as the days pass by. At the end of 
the sixth month, feeding every fourth hour suits 
some children well, but as a rule the three-hour 
interval must be adhered to from the fourth month 
to the end of lactation. 

Many authorities recommend additional artificial 
feedmg, alternating with nursing, after the sixth or 
eighth month. Such a plan is perfectly proper, if 
the babe ceases to gain strength and flesh while on 
the breast. If otherwise, the maxim of not inter- 
fering with any course that is doing well is as 
applicable here as elsewhere, and the breast may be 
relied upon entirely until the time comes for 
weaning. 

Should additional nutriment be required, the 
food must be selected with due reference to age and 
prepared in the same manner as in regular hand- 
feeding. 

The date of weaning cannot be fixed for all cases, 
since it must depend upon two conditions, — the 
health of the mother and the development of the 
child. When the former continues to be robust 
and the child steadily grows and gains flesh, lacta- 
tion can be prolonged until the tenth or twelfth 
month. If persevered in longer, the mother's 
strength begins to fail, her milk is lessened in 
quantity or becomes poor in quality, the child's 



FOOD. 157 

nutrition suffers, and he grows pale, thin and flabby, 
and may develop the disease known as rickets. 

Change in the manner of feeding may be accom- 
plished gradually or suddenly. In gradual weaning, 
about four weeks are required to prepare for the 
absolute withdrawal of the breast. For instance, 
if suck be given every three hours, from 5 a.m. 
until 1 1 p.m., or seven times a day, there should be, 
during the first week of preparation, one artificial 
feeding and six nursings daily ; during the second, 
two and five; during the third, four and three; 
during the fourth, six and one. Then the breast 
must be entirely withheld. Carefully prepared 
milk-food, administered from a bottle, is the best 
substitute. At the age of ten months a mixture 
that ordinarily agrees well is : — 

R . Cream I tablespoon ful. 

Milk 8 tablespoonfuls. 

Sugar of milk 1 teaspoonful. 

Water 3 tablespoonfuls. 

This is to be poured into a perfectly clean bottle, 
warmed in a water bath, and taken through a clean, 
plain rubber tip. Should the quantity (six fluid- 
ounces*) be insufficient to satisfy the child's 
appetite, all the ingredients except the cream may 

* One fluidounce = two tablespoonfuls. 
One fluidrachm = one teaspoonful. 



I58 HYGIENE OF THE NURSERY. 

be increased until the mixture measures eight or 
even twelve fluidounces, according to the demand. 

When such accidents as fever, disordered diges- 
tion, with vomiting and diarrhoea, or the actual 
cutting of one or more teeth occur during the 
period of preparation, the number of artificial 
feedings must be reduced, or the breast resumed 
until the disturbance be passed ; then the course 
may be begun again and carried to its completion. 

Usually there is little trouble in weaning infants 
in this way. Sometimes they become fretful under 
the change and may refuse food entirely for a day 
or more ; but a little determination on the part of 
the mother and the cravings of hunger will soon 
overcome this difficulty. 

Occasionally the child refuses to suck milk from 
a bottle or to drink it from a cup or spoon, in fact 
seems to object to any form of liquid food except 
that drawn from the mother, while at the same time 
he is eager for bread or other solid food. Under 
these circumstances prepare for each meal a 
moderate portion of either rice pudding or junket. 
After these have been taken for a day or two, add 
to each meal a little milk, reducing the amount of 
pudding or junket; stir the whole together and 
feed from a spoon ; next day still further reduce the 
solid and increase the liquid, and so proceed until 
finally a taste for milk is cultivated. 



FOOD. 1 59 

Sudden weaning is not advisable unless, while 
the breast is being presented, there is an absolute 
refusal to take artificial food from either a bottle or 
a spoon. This is most apt to occur when food has 
been given too frequently, and when the breast has 
been used as a means to quiet crying. The plan is 
also to be recommended when the mother's health 
becomes so affected as to render any further suck- 
ing a positive peril to the child's life ; attacks of 
erysipelas or of smallpox are instances in point. 

The physician is often forced to decide upon the 
advisability of premature weaning. His decision 
must be made cautiously and after thorough 
investigation of two propositions, namely : a, the 
effect of further lactation upon the health of the 
mother, and b, the requirements of the child. 

a. Lactation being a physiological process is not 
a drain upon the systemic strength so long as the 
functions of nutrition are actively performed, but 
under other circumstances it very frequently be- 
comes so. Premature weaning is necessary when 
the mother is attacked by any acute disease threat- 
ening dangerous temporary prostration, such as 
typhoid or typhus fever. A change must also be 
made if pulmonary consumption be developed, or, 
being already present, rapidly advances under the 
drain of milk secretion. Ordinarily, however, the 
general condition that leads to withdrawal of the 



l6o HYGIENE OF THE NURSERY. 

breasts is one of simple loss of strength and flesh 
on the part of the mother. 

Undoubtedly these indications often warrant the 
procedure, but every one who has seen much of 
children's practice must have met with many cases 
in which the advice to wean has been given care- 
lessly and unnecessarily, and in which the child 
might have had its natural food had proper atten- 
tion been given to the health of the mother. 

If a woman be worn out by household cares; if 
she wear herself out by a round of dinners, balls or 
shopping, or if she expose herself to injurious at- 
mospheric conditions and eats improper food, she 
grows weak and thin whether she be nursing or 
not ; and a woman heedless of her health will prob- 
ably care little whether she suckles her child or 
gives it up to a wet-nurse or to the bottle. 

In addition to making nursing the important duty 
of her life for the time being, a mother must be as 
free from household cares as possible. Mental and 
physical fatigue is to be avoided, sufficient exercise 
must be taken to maintain a healthy appetite and 
digestion, and abundant time devoted to rest and 
sleep. Beyond securing a plentiful supply of plain 
and easily digestible food, with a judicious portion 
of meat, vegetables, and fruit, it is unnecessary to 
give special attention to the diet. 

Should the secretion of milk be scanty, it may 



FOOD. l6l 

often be increased by the free use of animal broths, 
chocolate, gruel, or milk, and sometimes the moder- 
ate employment of stimulants, in the form of ale and 
porter, may be necessary. Such tonics as malt ex- 
tract, ferrated elixir of cinchona, bitter wine of iron, 
and the preparation known as " beef, wine and 
iron," are useful when there is ansemia, or when 
the general failure of strength cannot be overcome 
by food and attention to hygienic rules. 

The ordinary local conditions indicating the 
necessity of premature weaning, on the mother's 
account, are fissures of the nipple and mammary 
abscess. 

Fissure being usually a unilateral condition, it 
is only necessary to retire the affected side from 
duty and nourish the child alternately from the 
unaffected gland and from the bottle until healing 
takes place, the disabled breast being pumped in the 
meantime to keep up secretory activity. Should 
both sides be affected, weaning may be imperative, 
on account of the extreme pain produced by suck- 
ing, though, even under these circumstances, an 
effort must be made to maintain the flow of milk by 
regular pumping. Sometimes women are able to 
struggle through the attack by taking advantage of 
the relief and protection afforded by a nipple-shield. 

Fissures of the nipple may be preceded by vari- 
ous diseases of the delicate skin of the part. They 
ii 



l62 HYGIENE OE THE NURSERY. 

result, also, from want of cleanliness or from keep- 
ing- the nipple too moist, as when constant sucking 
is allowed or when there is a continual flow of milk. 
They may be prevented by proper attention to 
the nipple before confinement. During the latter 
months of pregnancy the clothing covering the 
breast must be loose, and the wearing of a wire tea- 
strainer over the nipple to prevent pressure has 
been recommended by one authority. Each day, 
for three months before labor, the nipples should 
be washed thoroughly with hot water in the even- 
ing and anointed with cocoa-butter in the morn- 
ing. At the same time, should the nipples be 
small or retracted, the woman must be taught to 
use her thumb and finger to draw them out. This 
process is not only an advantage in giving proper 
size and shape, but brings the skin into good con- 
dition without hardening it. The application of 
alcoholic and astringent lotions are not to be recom- 
mended. They tend to harden the tissue, which 
should be soft and pliable rather than tanned, and 
render the nipples liable to crack. 

When a fissure exists, it is best first to see whether 
or not nursing can be continued by means of a 
nipple-shield. Should the child refuse this, a good 
plan is to fill the shield with warm milk and invert 
it over the nipple. The infant then draws the fluid 
at once and without difficulty, and will often con- 



FOOD. 163 

tinue sucking until the breast milk follows. After 
nursing and removing the shield, the nipple must 
be dried thoroughly with absorbent cotton, and the 
following lotion applied with a camel's-hair brush : — 
Take of — 

Boracic acid twenty grains. 

Mucilage of acacia one fluidounce. Mix. 

b. On the part of the infant, there are several in- 
dications for anticipating the time of withdrawing 
the mother's breast. It must be done if the occur- 
rence of pregnancy or the recurrence of menstrua- 
tion render the milk unwholesome ; if the mother 
contracts a dangerous contagious disease, as small- 
pox, scarlet fever, or erysipelas ; if the mammary 
glands become inflamed ; if the breast does not 
afford sufficient nourishment and artificial food be 
refused ; and, finally, if dentition be markedly de- 
layed and the premonitory symptoms of rickets 
appear. As to the amount of nourishment, it must 
be remembered that the breast milk may be of good 
quality, but so diminished in quantity that it is in- 
sufficient ; or, while abundant in quantity, so poor 
in quality that it does not meet the demands of 
nutrition. Even without a minute examination of 
the milk, it is possible to form a good idea of which 
condition is present from the behavior of the infant 
in the act of sucking. If the milk be good in quality 
but deficient in quantity, the babe, when put to the 



164 HYGIENE OF THE ? V. 

bre zes the nipple as if famished, and dra 

upon it vigorous a time, and then drops it with 

:ream of rage. On the co: should there be 

an abundant supply of poor milk, the nipple 
grasped languidly, the child lies a long time at the 
breast and falls asleep there. Consideration of the 
final indication opens the question of the pre 
of regulating weaning by the progress of dentition. 
This is certainly a good guide, but not in the v, 
implied in the old precept, that the child must : 
be taken from the breast until evolution of the 
stomach and eye teeth. Insufficient food is one of 
the chief causes of rickets, and rickets more than 
any other disease delays dentition; consequen: 
should the teeth not pierce the gum in time, the 
inference is for other food rather than acontinua: 
of the faulty maternal sup: 

Upon deciding to anticipate the time of weaning, 
the next point to consider is whether the infant 
shall be brought up by hand or by a wet nun 

The advantage of 
feeding from the breast of a wet-nurse is that the 
mothers milk is substituted by the milk of another 
woman ; in other words, that natural feed:: ;>n- 

tinued — a matter of moment in and of in- 

estimable importance with delicate children. The 
disadvantage consists in the difficulty of finding, in 
a woman belonging to the class from which « 



FOOD. 165 

nurses come, all the moral and physical characters 
essential to a good substitute, and the fact that a 
stranger is introduced into the household, often to 
deceive and annoy the family, and on the slightest 
provocation to leave her charge to fate or to the 
tender mercies of another of her kind. For these 
reasons it is preferable, in the majority of instances, 
to trust to careful bottle-feeding. Nevertheless, as 
some children must have human milk if their lives 
are to be saved, the rules for selecting a wet-nurse 
must be understood. 

The woman chosen must be strong and robust, 
but rather spare than fat. Her bill of health must 
be perfectly free from hereditary tendency to men- 
tal or physical disease and from taint of syphilis, 
consumption or scrofula. She must be cheerful, 
good-natured, active, careful, and temperate in 
habits. Her age should be between twenty and 
thirty years ; she should understand the care of an 
infant and the manner of giving suck; her child 
ought to be nearly the same age as the infant to be 
adopted, and she must be able to afford an abundant 
supply of good milk. 

The last quality can be estimated by inspecting 
the breasts, by examining some of the milk drawn by 
a pump, and by ascertaining the condition of the wo- 
man's own child. The breasts of a good nurse are not 
necessarily large, but are firm to the touch and pyri- 



I 66 HYGIENE OF THE NURSERY. 

form in shape, with well-developed, prominent nip- 
ples, and with the skin distinctly marbled with large 
blue veins. The milk, which ought to flow readily 
on pressure or on suction, should be opaque and 
dull white in color, have a specific gravity of 1.03 1, 
an alkaline reaction, and show, when placed under 
the microscope, a number of minute, equal-sized, 
fat globules. Its quantity may be ascertained by 
weighing the child before and after sucking, the 
normal gain being from three to six ounces. There 
is, however, no better or more readily applied test 
of the quality of a nurse than the size, weight, and 
general development of her own child; and if it be 
weak and ill-nourished, no amount of fitness in other 
respects can warrant her engagement. 

Even when a woman is found fulfilling in her 
single person all the required conditions — a rare 
thing, indeed — it does not necessarily follow that 
her milk will suit the babe to be suckled. Then 
changes and new trials must be made until the 
desired end be attained. 

The diet of a wet-nurse and the manner of wean- 
ing, must be governed by the rules already given for 
maternal feeding. 

Personally, I have had such good results from 
carefully regulated bottle-feeding, that I have almost 
given up the employment of wet-nurses, preferring 
to regulate the artificial food myself rather than allow 



FOOD. 167 

an ignorant woman to supplement surreptitiously 
her deficient supply of breast milk by an unskilfully 
proportioned food — an event of not uncommon 
occurrence. 

3d. Artificial feeding. In my experience, there 
are few American women, especially in the well-to- 
do classes, who do not look upon the duty of 
nursing their babies as a pleasant one ; but there are 
many who are completely unable to do so, and a 
vast number in whom the secretion of milk fails 
after a few weeks or months of lactation. They 
must, therefore, through no fault of their own, resort 
to a wet-nurse or to artificial feeding. Usually, they 
select the last method, with results that vary in 
direct proportion to the care and intelligence dis- 
played in carrying it out. 

There is no artificial food equal to the milk of a 
robust woman. The fluid, however, secreted from 
the glands of a feeble or unhealthy mother, though 
often sufficient in quantity to fill the suckling's stom- 
ach and satisfy the cravings of hunger, does not 
contain enough pabulum to meet the demands of 
nutrition. In such unfortunate cases, good cows' 
milk, properly prepared, is a better food than the 
bad breast milk. More care and trouble, though, 
are involved in bottle than in breast feeding. If the 
child has been nourished in the natural way — i.e., 
breast-fed — even for a k\v weeks, or when the pow- 



1 68 HYGIENE OF THE NURSERY. 

ers of digestion are inherently active, the task is far 
easier to accomplish. In these cases the stomach 
and intestinal canal, inactive in foetal life, are trained 
to their new duties under normal conditions, and so 
prepared for the digestion of properly selected artifi- 
cial food. On the contrary, if digestion be naturally 
feeble, or if the infant must be bottle-fed from the 
first, great difficulty may be expected, and most 
skilful handling is necessary. 

To insure success in hand-feeding, it must be re- 
membered that an infant is not nourished alone by 
the food he swallows, but by that portion of it he 
digests and assimilates. The best diet, therefore, 
is one so adapted to age and digestive power that 
everything eaten will be digested and absorbed. 
But as children differ as much in constitution as in 
feature, it is impossible to formulate exactly a food 
that will be applicable to every case, or one that 
needs no change from month to month of progress- 
ing growth. As age and strength increase, there 
is a corresponding development of the gastrointes- 
tinal functions and a demand for more and stronger 
food. On the other hand, should the system be 
accidentally reduced by disease, the digestion, sym- 
pathizing in the general debility, temporarily loses 
its normal activity and assumes that of an earlier 
age. In such a case more nourishment is certainly 
needed to build up the failing strength, but it is to 



FOOD. 169 

be supplied by giving such food as can be com- 
pletely assimilated, and not by forcing down strong 
food merely because it is strong; for the latter, 
when not vomited, passes through the bowels un- 
digested, and the little creature starves to death in 
the midst of plenty, or dies from the ill effects of 
the constant presence of fermenting food in the ali- 
mentary canal. On these accounts many changes 
in diet, as to quality and quantity, must be antici- 
pated and made. 

Important matters, therefore, to be studied in de- 
tail are : a, the selection of a proper substitute for 
the breast milk ; b y the quantity to be given ; c y the 
method of preparation ; d y the mode of administra- 
tion ; and, e, the means of preservation. 

a. Healthy breast milk must be taken as the 
type of infants' food, and the nearer an artificial sub- 
stance can be made to approach it in chemical com- 
position and physical properties, the more perfect 
it is. 

Normal breast milk has a specific gravity of 1. 031. 
It is a persistently alkaline fluid, having a somewhat 
animal, usually disagreeable, and very rarely sweet- 
ish taste. It is bluish-white in color and thin and 
watery in consistence. 

According to Leeds' very thorough analysis, it 
contains : — 



I/O HYGIENE OF THE NURSERY. 

Water 86.766 per cent. 

Total solids 13.234 * 

Total solids not fat 9.221 " 

Fat 4.013 " 

Milk sugar 6.997 " 

Albuminoids 2.058 " 

Ash 0.21 " 

It contains, then, nitrogenous material, carbo- 
hydrates, salts and water — all the elements essential 
to repair tissue waste, to supply new material for 
growth and to maintain body heat, or, in other 
words, to constitute a perfect aliment ; and these, 
too, are so proportioned in the combination as to 
most easily and completely meet the demands. 

It must not be supposed, however, that the ele- 
ments are uniformly present in the same proportion. 
On the contrary, the fluid varies both at different 
periods of lactation and in different individuals. 

This fact is the most striking feature of the 
above observer's work, which shows that the most 
changeable constituent is the albumen, varying from 
a maximum of 4.86 per cent, to a minimum of 
0.85 ; the next are the fats and salts, the maximum 
being about three times the minimum, and the least 
the sugar. The latter, in fact, varies but little from 
a standard of about 7 per cent. The function of 
albumen is nutritive ; that of milk sugar calori- 
facient; hence the point seems to be that nature, 
while allowing a wide range of oscillation in the 



FOOD. 171 

rapidity of tissue building, carefully provides an 
available fuel for the constant maintenance of animal 
heat ; the supply of caloric due to cerebral impulses 
and self- originated locomotion being extremely 
small in early infancy. 

In seeking a substitute for human milk, one natur- 
ally turns to the domestic animals for the source of 
supply. Between the milk of the ass, cow, goat and 
ewe there is little choice, so far as composition is 
concerned, though, perhaps, asses' milk resembles 
that of women a little more closely than the others; 
nevertheless, cows' milk is usually selected, because, 
being plentiful, it is easily obtained and cheap. 

Cows' milk* (market milk) has a specific gravity 
of 1.029, is richer looking — that is, whiter and more 

* The characters of cows' milk may be determined with sufficient 
accuracy in the following way : — 

Provide a urinometer, such as shown in Fig. 1 8, and which can 
be obtained at any drug shop. To obtain the specific gravity, fill 
the beaker to such a point with milk that it will float the specific 
gravity glass, and read the degree of density from the scale at a 
level with the surface of the milk. The chemical reaction is found 
by inserting a piece of blue litmus paper, which should turn slightly 
red a few moments after being wet. In applying this test small 
pieces of litmus paper should be examined under and in the milk, 
as exposure to air may redden paper dipped in milk though the 
fluid itself may not be acid. To ascertain the proportion of cream, 
cut a narrow strip of paper four inches long, and divide the upper 
half-inch, by cross- markings, into twelve equal parts; paste this on 
the beaker with the marked portion uppermost, and the lower edge 
coming accurately to the bottom of the beaker; then pour in enough 



172 



HYGIENE OF THE NURSERY. 



opaque than human milk, and is slightly acid in 
reaction unless perfectly fresh from pasture-fed 
animals, when it may be neutral or alkaline, and 
contains — 

Water 87. 7 per cent. 

Total solids 12.3 

Total solids not fat 8.48 

Fat 3 75 

Milk sugar 4.42 

Albuminoids 3.42 

Ash 0.64 



Fig. 18. 



E_ 



LACTOMETER. 



Comparing this analysis with that 
previously given, it is readily seen 
that the two fluids differ in specific 
gravity and reaction, and that 
cows' milk contains more nitro- 
genous material, but less fat and 
much less sugar than woman's milk. 

The nitrogenous material differs 
in quality as well as in quantity. 
Konig, in a number of analyses that 
closely correspond with those of 
Leeds, divides the nitrogenous con- 
stituent into three groups; namely, 
caseine, albumen and albuminoids, 



milk to come just to the top of the paper, and place the whole aside 
for twenty- four hours. During this time the cream rises and appears 
as a yellow layer at the top ; this layer should have the depth of ten 
or twelve spaces. 



FOOD. 173 

basing the division upon the different effects of 
coagulating agents. 

Upon this point Leeds remarks : " Whilst by 
present modes of analysis the separation of the 
so-called caseine from the so-called albumen is not 
accurately performed, yet the results are approxi- 
mately correct (Konig's), and have a very great 
value in pointing out the most important of all the 
differences between the two secretions, which is, 
that the fraction of the total albuminoids in cows* 
milk which is coagulable by acids is far greater 
(perhaps four times) than the non-coagulable part. 

" In woman's milk, on the contrary, the reverse is 
true, and the non-coagulable part much exceeds 
(perhaps by more than twice) the coagulable 
portion. ,, 

This difference is readily tested by adding rennet 
to the two fluids. In the case of cows' milk the 
caseine is coagulated into large, firm masses, while 
with human milk a light, loose curd is formed. In 
the stomach the acid gastric juice has the same 
effect, producing in the first instance a coagulum 
most difficult to digest; in the other, one readily 
attacked and broken down by the gastro-intestinal 
solvents. 

These chemical and physical properties of cows' 
milk can be altered by various methods of prepa- 
ration, and unless this be done there are few in- 



HYGIENE OF THE NURSERY. 

nces in which it will not prove a poor substitute 
for the natural food. 

Condensed milk is frequently recommended by 
physicians and largely used by the laity, on their 
own responsibility. It keeps better than cows' 
milk and is supposed to be more readily digested 
by young infants. The latter supposition is a mis- 
taken one, and arises from the overlooked fact that 
condensed milk is always given dissolved in a large 
proportion of water, while cows' milk is too 
frequently used insufficiently diluted or otherwise 
improperly prepared. The author is convinced of 
the accuracy of this statement from a number of 
years' close study of the subject. 

Condensed milk contains a large proportion of 
sugar, forms fat quickly, and thus makes large 
babies ; sugar also counteracts the tendency to con- 
stipation — often a troublesome complaint in hand- 
feeding. These advantages are unquestioned, and, 
together with the ease of preparation, are those 
which place it so high in the esteem of monthly 
nurses. It is equally true, however, that as a food 
it does not contain enough nutrient material to 
supply the wants of a growing baby. 

_;ain, more than half of the saccharine ingre- 
dient of this preparation is cane sugar, added for 
the purpose of preservation, and this material is 
very liable, when in excess, to ferment in the 



FOOD. 175 

alimentary canal, giving rise to irritant products that 
impede digestion. 

Infants fed upon condensed milk, though fat, are 
pale, lethargic and flabby ; although large, are far 
from strong ; have little power to resist diseases ; 
often cut their teeth late, and are very likely to 
drift into rickets. It must be remembered also that 
condensed milk, when long kept, or when packed in 
imperfect cans, not unfrequently undergoes decom- 
position, and thus becomes utterly unfit for use. 

For a temporary change of diet, and as a sub- 
stitute during travelling or under circumstances in 
which sound cows' milk cannot be obtained, it may 
be resorted to with advantage. 

The farinaceous substances so often selected, 
especially by the poor, to replace breast-milk, are 
not only bad foods, but have both directly and in- 
directly a deleterious effect upon the processes of 
nutrition. 

They are bad for two reasons. First, they differ 
materially in chemical composition from human 
milk. For example, in arrowroot, which is the 
favorite, the proportion of the tissue-building to the 
heat-producing element is as one to twenty, while 
in human milk it is about one to five. Secondly, the 
heat-producing principle, starch, must be converted 
into sugar before it can be absorbed. This change 
is accomplished in the body by the saliva and pan- 



176 HYGIENE OF THE NURSERY. 

creatic juice, — secretions that are not fully estab- 
lished until the fourth month. 

While the starch lies undigested in the gastro- 
intestinal canal, it is subject to fermentation, result- 
ing in the formation of irritant products that rapidly 
induce catarrh of the mucous membrane; a con- 
dition directly interfering with the digestion and 
absorption of food. Again, perfect nutrition 
demands rapid waste and removal of effete tissues 
as well as repair of the same. This is effected by 
oxidation. Now sugars are known to have a much 
greater affinity for oxygen than albuminates, and 
when the diet consists of farinaceous material, the 
little sugar formed and absorbed appropriates 
oxygen that otherwise would go toward the 
removal of waste, and so retards the necessary 
changes. 

Farinaceous food, as such, is never permissible 
before the fourth month ; earlier, it is only to be 
employed for its mechanical action, as an addition 
to milk preparations. This will be mentioned later. 

The nutrient value of the cereals and their pro- 
ducts as they exist in so-called "infants' foods," 
has been imperfectly determined. They are un- 
doubtedly useful as mechanical attenuants, but it 
is very questionable whether any of them, unless 
prepared with milk, can permanently meet the 
demand of nutrition. At the same time it is quite 



FOOD. 177 

probable that the soluble albuminoid substances 
obtained by Liebig's process have a food value of 
their own, making them more serviceable than the 
starches. 

b. The quantity of food to be allowed each day 
varies with the appetite and age. Some infants 
habitually eat little, others much ; as both thrive, 
the question of the correct amount in a given case 
must be answered by observation. So long as the 
child develops with normal rapidity and keeps well, 
he may be allowed to eat as much or as little as he 
wants ; for, if food of proper strength be given at 
proper intervals, the instinctive cravings of hunger, 
since they represent the wants of the system, rarely 
lead to excess in either direction. Nevertheless it 
is well to have some guide. 

During the first four weeks, infants generally re- 
quire from twelve and-a-half to sixteen fluidounces 
of food ; in the second and third months, about 
twenty-four fluidounces, and from this time to the 
twelfth month from two to two and-a-half or even 
three pints. After the twelfth month the quantity 
depends upon whether additions be made to the 
diet, or milk food be used exclusively. When the 
daily amount reaches three pints, the limit of the 
capacity of the stomach is usually attained, and the 
greater demand for nutriment, as growth advances 

month by month, must be met by adding to the 
12 



I78 HYGIENE OF THE NURSERY. 

strength of the food rather than by increasing its 
bulk. These two factors, strength and quantity, are 
intimately associated throughout the whole period 
of infancy, and in the earlier months a mere increase 
in the latter is not always sufficient to maintain the 
balance of nutrition. 

As a rule, infants are overfed, and this opens the 
very interesting question of the normal capacity of 
the stomach at different ages. Rotch has recently 
written an important paper upon the subject. He 
states that, by actual measurement, the stomach of 
an infant five days old holds 25 c.c, or six and-a- 
quarter fluidrachms, a quantity very far short of 
that usually forced upon the babe during the first 
week. Frowlowsky's investigations show that there 
is a very rapid increase in the capacity of the stom- 
ach during the first two months of life, while in the 
third, fourth and fifth months the increase is slight. 
Guided by these data, the quantity of food should 
be rapidly augmented during the first six or eight 
weeks of life and then held at the same quantity up 
to the fifth or sixth month. Another considerable 
increase is also demanded between the sixth and 
the tenth months. 

While the author has been unable to verify the 
above measurements, and has, on the contrary, 
found no uniformity in the size of the stomach for 
given ages, yet the following table (Rotch) is a use- 



FOOD. 



179 



ful one, and corresponds closely with conclusions 
drawn from clinical experience : — 

GENERAL RULES FOR FEEDING. 



Age. 


Intervals of 
Feeding. 


Average Amount at 
Each Feeding. 


Average Amount in 
24 Hours. 


First week. 


2 hours. 


1 ounce. 


10 ounces. 


One to six weeks. 


2^ hours. 


x% to 2 ounces. 


12 to 16 ounces. 


Six to twelve weeks 
and possibly to fifth or 
sixth month. 


3 hours. 


3 to 4 ounces. 


18 to 24 ounces. 


At six months. 


3 hours. 


6 ounces. 


36 ounces. 


At ten months. 


3 hours. 


8 ounces. 


40 ounces. 



c. The object to be accomplished in the prepara- 
tion of cows' milk is to make it resemble human 
milk as much as possible in chemical composition 
and physical properties. To do this, it is necessary 
to reduce the proportion of caseine, to increase the 
proportion of fat and sugar, and to overcome the 
tendency of the caseine to coagulate into large, firm 
masses upon entering the stomach. 

Dilution with water is all that need be done to 
reduce the amount of caseine to the proper level ; 
but as this diminishes the already insufficient fat 



ISO HYGIENE OF THE NURSERY. 

and sugar, it is essential to add these materials to 
the mixture of milk and water. Fat is best added 
in the form of cream, and of the sugars, either pure 
white loaf sugar or sugar of milk may be used. 
The latter is greatly preferable, as it is little apt to 
ferment, and contains some of the salts of milk, 
which are of nutritive value. 

Firm clotting may be prevented by the addition 
of an alkali or a small quantity of some thickening 
substance. 

Lime water is the alkali usually selected. It acts 
by partially neutralizing the acid of the gastric 
juice, so that the caseine is coagulated gradually 
and in small masses, or passes, in great part, un- 
changed into the intestine, to be there digested by 
the alkaline secretions. As it contains only half a 
grain of lime to the fluidounce, the desired result 
cannot be attained, unless at least a third part of the 
milk mixture be lime water. The quantity often 
used — one or two teaspoonfuls to the bottle of food 
— has no effect beyond neutralizing the natural 
acidity of the milk itself. When lime water is con- 
stantly employed, it becomes quite an item of ex- 
pense if procured from the drug shop ; this outlay 
is unnecessary, for it can be made quite as well in 
the nursery. Take a piece of unslaked lime as large 
as a walnut, drop it into two quarts of filtered water 
contained in an earthen vessel, stir thoroughly, allow 



fooi>. 181 

to settle, and use only from the top, replacing the 
water and stirring as consumed. 

Instead of lime water, two to four grains of bi- 
carbonate of sodium may be added to each bottle, 
or, better still, from five to fifteen drops of the sac- 
charated solution of lime. 

This solution is made in the following way : — 

Take of — 

Slaked lime I ounce. 

Refined sugar, in powder 2 ounces. 

Distilled water I pint. 

Mix the lime and sugar by trituration in a mortar. Transfer the 
mixture to a bottle containing the water, and having closed this 
with a cork, shake it occasionally for a few hours. Finally, 
separate the clear solution with a siphon and keep it in a stop- 
pered bottle. 

Thickening substances — attenuants, such as bar- 
ley-water, gelatine, or one of the digestible prepared 
foods — act purely mechanically by getting, as it 
were, between the particles of caseine during co- 
agulation, preventing their running together and 
forming a large, compact mass. 

When an " infant's food " is used to act mechani- 
cally, care should be taken to select one in which 
the starch has been converted into dextrine and 
grape sugar by the process of manufacture. The 
articles known as " Mellin's Food " and " Horlick's 
Food " can be relied upon. One teaspoonful of 



1 82 HYGIENE OF- THE NURSERY. 

either dissolved in a tablespoonful of hot water and 
added to each portion of food, makes a very easily 
digested mixture. 

For the successful management of children, the 
mother or nurse must not only be familiar with 
the theory of feeding, but must practically under- 
stand the methods of preparing food. To this 
end a schedule of the diet of an infant from birth 
upward, with a sketch of the modifications that 
have to be made most frequently, will serve as a 
useful guide. 

Diet during the first week: — 

Cream 2 teaspoonfuls. 

Whey 3 teaspoonfuls. 

Water (hot) 3 teaspoonfuls. 

Milk sugar ^ teaspoonful. 

For each portion ; to be given every two hours from 5 A. M. to 1 1 
P. If., and in some cases once or twice at night ; amounting to 
twelve fluidounces of food per diem. 

Diet from the second to the sixth week: — 

Milk I tablespoonful. 

Cream 2 teaspoonfuls. 

Milk sugar % teaspoonful. 

W T ater 2 tablespoon fuls. 

For one portion; to be given every two hours from 5 A. M. to 1 1 
P. M. ; amounting to seventeen fluidounces of food per diem. 

Diet from the sixth week to the end of the sec- 
ond month : — 



FOOD. 183 

Milk 2 x / 2 tablespoonfuls. 

Cream I tablespoonful. 

Milk sugar ^ teaspoonful. 

Water 2^ tablespoonfuls. 

For each portion ; to be given every two hours ; amounting to thirty 
fluidounces per diem. 

Diet from the beginning of the third month to 
the sixth month : — 

Milk 5 tablespoonfuls. 

Cream 1 tablespoonful. 

Milk sugar 1 teaspoonful. 

Water 2 tablespoonfuls. 

For each portion ; to be given every two and a half hours, or thirty- 
two fluidounces per diem. 

Diet during the sixth month; six meals daily 
from 6 or 7 a. m. to 9 or 10 p. m. 

Morning and mid-day bottles each : — 

Milk 9 tablespoonfuls. 

Cream I tablespoonful. 

Mellin's Food I teaspoonful. 

Hot water 2 tablespoonfuls. 

Dissolve the Mellin's Food in the hot water and add, with stirring, 
to the previously mixed milk and cream. 

Other bottles each : — 

Milk 9 tablespoonfuls. 

Cream 1 tablespoonful. 

Milk sugar 1 teaspoonful. 

Water 2 tablespoonfuls. 

This gives an equivalent of thirty-six fluidounces 
of food in a day. 



184 HYGIENE OF THE NURSERY. 

In the seventh month the Mellin's Food may be 
increased to two teaspoonfuls and given three times 
daily. 

Throughout the eighth and ninth months five 
meals a day will be sufficient. 

First meal at 7 a. m. : — 

Milk 13 tablespoon fuls 

Cream 1 tablespoonful. 

Milk sugar I teaspoonful. 

Water 2 tablespoon fuls. 

Second meal at 10.30 a.m. Milk, cream and 
water in the same proportion ; Mellin's Food, one 
tablespoonful. 

Third meal at 2 p. m. — Same as second. 

Fourth meal at 6 p. m. — Same as second. 

Fifth meal at 10 p. m.-— Same as first. 

This gives forty fluidounces of food per diem. 

Instead of Mellin's Food, a teaspoonful of " flour- 
ball " * may be added. 

Two meals of flour-ball daily — the second and 
fourth — are all that can be digested. To prepare 
these, rub one teaspoonful of the powder with a 
tablespoonful of milk into a smooth paste, then add 
a second tablespoonful of milk, constantly rubbing 
until a cream-like mixture is obtained. Pour this 
into eight ounces of hot milk, stirring well, and it 

* See Chap. IX. 



food; 185 

is then ready for use. The other meals should be 
composed of milk, cream, sugar of milk and water, 
as already given. 

Mellin's Food and flour-ball may be substituted 
by oatmeal or barley, or any one of the infants' 
foods in which the starch has been converted, by 
Liebig's process, into dextrine and grape sugar. 

Diet for the tenth and eleventh months : — 

First meal, 7 A. m. : — 

Milk 17 tablespoonfuls. 

Cream . , I tablespoonful. 

Mellin's Food I tablespoonful. 

(Or flour-ball or barley jelly*) . . 2 teaspoonfuls. 
Water (used only with Mellin's Food), 2 tablespoonfuls. 

Second meal, 10.30 a.m. — A breakfast-cupful of 
warm milk (eight fluidounces). 

Third meal, 2 p. m.— The yelk of an egg lightly 
boiled, with stale bread crumbs. 

Fourth meal, 6 p. m. — Same as first. 

Fifth meal, 10 p.m. — Same as second. 

On alternate days the third meal may consist of 
a teacupful (six fluidounces) of beef tea containing 
a few stale bread crumbs. 

A further variation can be made by occasionally 
using mutton, chicken or veal broth instead of beef 
tea.f 

*See Chap. ix. f Ibid. 



1 86 HYGIENE OF THE NURSERY. 

As much more difficulty is experienced in feed- 
ing infants during the first twelve months than 
during the second, it would be well to pause here 
to consider what had best be done in case the food 
described should disagree. 

If, after feeding, vomiting occur, with the expul- 
sion of large, firm clots of caseine, the effect of add- 
ing lime water or barley water must be tried. 

For instance, at the age of six weeks make each 
bottle of:— 

Milk 2 l / 2 tablespoon fuls. 

Cream I tablespoonful. 

Milk sugar ]/ 2 teaspoonful. 

Lime water 2]/ 2 tablespoonfuls. 

Or of:— 

Milk 2j£ tablespoonfuls. 

Cream I tablespoonful. 

Milk sugar ]/ 2 teaspoonful. 

Barley water 2)/ 2 tablespoonfuls. 

Sometimes, particularly if there be diarrhoea, boil- 
ing makes the milk more tolerable, and in this con- 
dition it may be used instead of fresh milk in either 
of the above mixtures. Condensed milk, too, can 
be employed temporarily, making each portion of: — 

Condensed milk I teaspoonful. 

Cream I tablespoonful. 

Hot water 5 tablespoonfuls. 



FOOD; 187 

Should further alteration be necessary, goats' or 
asses' milk may be substituted for cows' milk, the 
strong odor of the former and the laxative proper- 
ties of the latter being removed by boiling. One 
ass is capable of nourishing three children for the 
first three months of life, two children for the fourth 
and fifth months, and one child after this period to 
the ninth month. The milk should be used warm 
from the udder. 

" Strippings " is another good substitute for cows' 
milk. It is obtained by re-milking the cow after 
the ordinary daily supply has been drawn, and con- 
tains much cream and but little curd. Assimilable 
proportions of this are : — 

Strippings 2 tablespoonfuls. 

Water 4 tablespoonfuls. 

And if the small amount of caseine, in such a 
mixture, be still undigested : — 

Strippings . 3 tablespoonfuls. 

Barley water 3 tablespoonfuls. 

Another good food is that recommended by Dr. 
A. V. Meigs. It consists of a combination of two 
parts of the cream, containing from fourteen to six- 
teen per cent, of fat ; one part average milk ; two 
parts lime water, and three parts sugar water, the 
latter consisting of seventeen and three-fourths 



iSS HYGIENE OF THE NURSERY. 

drachms * of milk sugar to one pint of water. This 
makes an alkaline mixture with the percentage of its 
ingredients closely corresponding to human milk. 

When, in spite of careful preparation, all of these 
foods give rise to indigestion with fever, and the 
expulsion, by vomiting and diarrhoea, of hard curds 
from the stomach and intestines, the expedient of 
predigesting the milk must be resorted to. 

The best method is to peptonize the milk by 
pancreatin. f That manufactured under the name 
of extractum pancreatis, by Fairchild Brother & 
Foster, of New York, has proved most efficient in 
my hands. To accomplish this artificial digestion, 
put into a clean quart bottle five grains of extractum 
pancreatis, fifteen grains of bicarbonate of sodium, 
and four fluidounces of cool, filtered water; shake 
thoroughly together, and add a pint of fresh, cool 
milk. Place the bottle in water, not so hot but that 
the whole hand can be held in it for a minute with- 
out discomfort, and keep the bottle there for exactly 
thirty minutes. At the end of that time put the 
bottle on ice to check further digestion and to keep 
the milk from spoiling. The fluid obtained, while 
somewhat less white in color than milk, does not 
differ from it in taste ; if, however, an acid be 

* About eighteen teaspoonfuls. 

f The subject of peptonization is further considered in Chapter IX. 



FOOD. 189 

added, the caseine, instead of being coagulated into 
large, firm curds, takes the form of minute, soft 
flakes, or readily broken-down feathery masses of 
small size. When the process is carried just to the 
point described, the caseine is only partly converted 
into peptone ; but every succeeding moment of con- 
tinued warmth lessens the amount of caseine until 
peptonization is complete. Then the liquid is gray- 
ish yellow in color ; has a distinctly bitter taste, and 
shows no coagulation whatever on the addition of 
an acid. This artificial digestion, therefore, may be 
carried just as far as circumstances indicate, although 
it is ordinarily best to stop it short of complete con- 
version, as children object to the markedly bitter 
taste, and often, on account of it, absolutely refuse 
the food. Partial peptonization, too, is usually suf- 
ficient to adapt the milk to ready assimilation. To 
seize the proper moment for arresting the process, 
the person conducting it must be told to taste the 
milk from time to time, and as soon as the least 
bitterness is appreciable, to remove the bottle from 
the hot water and place it upon ice for cooling and 
use. Such milk may be sweetened with sugar of 
milk, and given pure or diluted with water. For an 
infant of six weeks each meal may consist of: — 

Peptonized milk 6 tablespoonfuls. 

MiJk sugar y^ teaspoonful. 

Water 2 tablespoonfuls. 



I9O HYGIENE OF THE NURSERY. 

To this, cream may be added when desirable, and 
by diminishing the quantity of water and increasing 
that of milk the strength of the food may be made 
greater at any time. 

Although every precaution be taken, the last of 
a quantity of predigested food is very apt to grow 
bitter ; and if the attendants will take the trouble, it 
is much better to peptonize every meal separately. 
This is readily done by obtaining a number of pow- 
ders of pancreatin and bicarbonate of sodium, so 
proportioned that each packet shall contain the 
proper amount for one bottle of food. 

For example : — 

Take of — 

Extractum pancreatis ..... nine grains. 

Bicarbonate of sodium twenty-four grains. 

Mix and divide into twelve powders, and dispense in waxed papers. 

Directions. — Put one powder into a nursing bottle with two 
fluidounces of filtered water and two fluidounces of fresh sweet 
milk ; shake together and keep warm in a water-bath for about 
half an hour before feeding ; sweeten with half a teaspoonful 
of milk sugar. 

The great advantages of partial peptonization are 
that the necessity for lime water, barley water and 
thickening substances to keep apart the curd is 
done away with, and that, when the digestive dis- 
turbance requiring a careful preparation of food is 
removed, an ordinary milk diet can be gradually re- 
sumed by regularly diminishing the time artificial 



FOOD. I9I 

digestion is allowed to progress. This changes the 
caseine in a less and less degree, until, finally, it is 
taken in its natural form. 

Instead of this ordinary peptonizing process, I 
have for the past year or more employed the 
" Peptogenic milk powder/' prepared by the 
chemists already referred to. This powder con- 
tains a digestive ferment, pancreatin; an alkali, 
bicarbonate of sodium, and a due proportion of 
milk sugar. 

The mode of employment is as follows : — 

Take of — 

Milk 4 tablespoonfuls. 

Water 4 tablespoonfuls. 

Cream I tablespoonful. 

Peptogenic milk powder . , , , 1 measure.* 

This mixture is to be heated over a brisk flame 
to a point that can be comfortably sipped by the 
preparer (about 115 F.) and kept at this heat for 
six minutes. When properly prepared, the resul- 
tant, so-called " humanized milk," presents the 
albuminoids in a minutely coagulable and digestible 
form ; has an alkaline reaction ; contains the proper 
proportion of salts, milk sugar and fat, and has the 
appearance of human milk. 

* Measure provided with each can of powder. 



192 HYGIENE OF THE NURSERY. 

Leeds gives the following analysis of this pre- 
pared milk : — 

Water 86.2 per cent. 

Fat 4.5 

Milk sugar 7. " 

Albuminoids 2. " 

Ash (salts) 0.3 " 

Fig. ig. 




AUTHOR S STERILIZER. 



This corresponds very closely with his average 
analysis of human milk. 

In using this powder, too, one can readily return 
to a plain milk diet by gradually shortening the 



FOOD. I93 

time of heating, thus slowly diminishing pre- 
digestion. 

Great stress has been placed upon " Sterilization " 
as a process of purifying and preserving cow's milk. 
It consists in subjecting the fluid to high heat 
under pressure. The implements devised by the 
author for this purpose are shown in Figure 19. 

The apparatus is made of tin, and consists of an oblong case provided 
with a well-fitting cover, and having a movable perforated false bottom 
(d), which stands a short distance above the true one, and has attached a 
framework capable of holding ten six-ounce nursing bottles. On the 
outside of the case is a row of supports (b) for holding inverted bottles 
while drying, and at the proper distance below these a gradually inclining 
gutter (c) for carrying off the drip. A movable water bottle (a) is hung to 
the side ; in this each bottle of food may be heated at the time of adminis- 
tration. Ten bottles made of flint glass, and according to the design 
described on page 203, are used, so that the whole supply of milk intended 
for a day's consumption can be prepared at once. Each bottle is provided 
with a perforated rubber cork, which in turn is closed by a well-fitting 
glass stopper. 

Sterilization should be performed in the morning as soon as possible 
after the milk has been served. The process is as follows : First, see that 
the ten bottles are perfectly clean and dry ; pour into each six fluidounces 
(12 tablespoonfuls) of milk ; insert the perforated rubber corks — without 
the glass stoppers, however ; remove the false bottom and place the bottles 
in the frame ; pour into the case enough water to fill it to the height of 
about two inches ; replace the false bottom carrying the bottles ; adjust 
lid, and put the whole on the kitchen range. Allow the water to boil and, 
by occasionally removing the lid, ascertain that the expansion that imme- 
diately precedes boiling has taken place in the milk, then press the glass 
stoppers into the perforated corks, and keep the apparatus on the fire and 
the water boiling for twenty minutes. Finally, remove the false bottom 
with the bottles ; pour out the water, replace, and carry the whole, covered 
with the lid, to the nursery. 

Sterilized milk may, of course, be diluted with 
filtered water, or receive the additions ordinarily 
made to adapt it to children of different ages. It 
13 



IQ4 HYGIENE OF THE NURSERY. 

will remain sound for many days, and is especially 
adapted to traveling, when fresh milk cannot be 
obtained, and for use in cities during the heat of 
summer, when milk is most apt to undergo injurious 
changes. 

But the necessary prolonged subjection of the 
milk to a high temperature under pressure produces 
certain changes in its composition which render it 
difficult to digest ; on this account many children 
do not thrive upon it. 

Pasteurization or sterilization at a low temperature 
is a far safer and more uniformly applicable pro- 
cedure, and should supplant the old process for 
general nursery use. 

Methods of Pasteurizing milk in bulk have been 
advanced both in Germany and in our own country, 
and lately an easily managed procedure and appa- 
ratus have been devised for domestic use, based 
upon the theory that the required temperature 
(155 F.) can be secured by immersing a definite 
quantity of milk in a properly proportioned bulk 
of boiling water, the source of heat having been 
withdrawn. The apparatus is made up of two 
parts, a graduated pail with a tight-fitting cover 
for the water and a receptacle for bottles containing 
the milk. This receptacle consists of a series of 
seven or ten hollow zinc cylinders fastened together, 
and fits into the graduated pail. Each cylinder holds 



FOOD. 195 

a bottle of milk, the series of seven accommodating 
seven eight-ounce bottles, that of ten, ten six-ounce 
bottles. When the bottles are in place, water is 
poured around them to secure perfect conduction 
of the heat. Having heated the required quantity 
of water in the pail to thorough boiling, the latter 
is removed from the stove and placed on a wooden 
table, the cylinders are then introduced, the pail 
covered, and the whole allowed to stand for thirty 
minutes ; finally, the milk is rapidly cooled by 
placing the bottles in a refrigerator or immersing 
them in cold water. Milk thus treated is sufficiently 
aseptic, is unaltered in digestibility, and when kept 
cold shows no change for several days. 

A sufficiently perfect apparatus may be readily 
improvised. All that is required is a bottle rack 
similar to that of the Arnold's sterilizer, and a tin 
pail large enough to receive the rack and bottles and 
provided with a well-fitting cover. In conducting 
the process fill the bottles, previously perfectly 
cleaned, with milk, and stop them with cotton, 
place them in the rack, and this in turn in the pail, 
pour into the pail enough boiling water to come 
up to the level of the milk in the bottles, adjust 
the cover, and let the whole stand on a wooden 
table until the water becomes cool, about thirty 
minutes ; lastly, place the bottles in a refrigerator. 
I have found no difficulty in keeping milk so pre- 



I96 HYGIENE OF THE NURSERY. 

pared perfectly sound and sweet for twenty-four 
hours. 

Leeds has suggested a modified Pasteurization 
which is most serviceable. It consists in heating the 
milk, rendered feebly alkaline with lime-water or 
bicarbonate of sodium, to I55°F. for six minutes, 
or, better still, of applying the same amount of heat 
to milk containing pancreatin and bicarbonate of 
sodium or peptogenic milk powder. By the latter 
method the milk is both sterilized and predigested: 
if not used at once, it must be momentarily heated 
to the boiling point to check peptonization before 
the development of a bitter taste. 

Sometimes milk, in every form and however care- 
fully prepared, ferments soon after being swallowed 
and excites vomiting, or causes great flatulence 
and discomfort, while it affords little nourishment. 
With these cases the best plan is to withhold milk 
entirely for a time and try some other form of food. 
The following are good substitutes : — 

Mellin's Food I teaspoonful. 

Hot water 6 tablespoon fuls. 

For each portion ; to be given every two hours at the age of six 
weeks. 

Veal broth (^ ft), of meat to the pint) 3 tablespoonfuls. 

Barley water 3 tablespoonfuls. 

For one portion. 

Whey 3 tablespoonfuls. 

Barley water 3 tablespoonfuls. 

Milk sugar y 2 teaspoonful. 



FOOD. 197 

A teaspoonful of the juice of raw beef* every 
two hours will usually be retained when everything 
else is rejected. 

Such foods are only to be used temporarily until 
the tendency to fermentation within the alimentary 
canal ceases ; then milk may be gradually and cau- 
tiously resumed. 

When infants approaching the end of the first 
year become affected with indigestion, it is often 
sufficient to reduce the strength and quantity of the 
food to a point compatible with digestive powers. 
For instance, at eight months the food may be 
reduced to that proper for a healthy child of six 
months, or even less. Here, too, predigestion of 
the food is very serviceable. 

If a few grains of extractum pancreatis be added 
to a gobletful of thick, well-boiled starch gruel, at 
a temperature of ioo° F., the gelatinous mucilage 
quickly grows thinner and soon is transformed into 
a fluid, the starch having been rendered soluble by 
the action of the pancreatin ; by still longer con- 
tact, the hydrated starch is converted into dextrine 
and sugar. Advantage may be taken of this prop- 
erty to render the foods containing starch assimi- 
lable. Thus, to a mixture of barley jelly and milk, 

* See Chapter ix. 



I98 HYGIENE OF THE NURSERY. 

Barley jelly 2 teaspoonfuls. 

Milk sugar I teaspoonful. 

Warm milk 16 tablespoonfuls. 

Add three grains of extractum pancreatis, and five grains of bicar- 
bonate of sodium, and keep warm for half an hour before ad- 
ministering. 

The same process may be employed with food 
containing oatmeal, arrowroot or wheaten flour, 
with a view of converting the starchy ingredients 
into digestible elements without materially altering 
the taste. 

When the infant has arrived at an age to take 
meat broths, these too, when digestion is enfeebled, 
may be readily peptonized.* 

Returning to the regimen of the healthy infant, it 
will be found that after the first year far less change 
is required in the food from month to month. 

Diet from the twelfth to the eighteenth month, 
five meals per day : — 

First meal, 7 a. m. — A slice of stale bread, broken 
and soaked in a breakfast-cup (eight fluidounces) of 
new milk. 

Second meal, 10 a.m. — A teacup of milk (six 
fluidounces) with a soda biscuit or thin slice of 
buttered bread. 

Third meal, 2 p. m. — A teacup of beef tea (six 

* See Chapter ix. 



FOOD. I99 

fluidounces) with a slice of bread. One good 
tablespoonful of rice-and-milk pudding. 

Fourth meal, 6 p. m. — Same as first 

Fifth meal, 10 p. m.— One tablespoonful of Mel- 
on's Food with a breakfast-cupful of milk. 

To alternate with this : — 

First meal, 7 A. m. — The yelk of an egg lightly- 
boiled, with bread crumbs ; a teacupful of new milk. 

Second meal, 10 A. m. — A teacupful of milk with 
a thin slice of buttered bread. 

Third meal, 2 p.m. — A mashed baked potato, 
moistened with four tablespoonfuls of beef tea ; two 
good tablespoonfuls of junket. 

Fourth meal, 6 p. m. — A breakfast-cupful of new 
milk with a slice of bread broken up and soaked 
in it. 

Fifth meal, 10 p. m. — Same as second. 

The fifth meal is often unnecessary, and sleep 
should never be disturbed for it ; at the same time, 
should the child awake an hour or so before the 
first meal, he must break his fast upon a cup of warm 
milk, and not be allowed to go hungry until the set 
breakfast hour. 

Diet from eighteen months to the end of two and 
one-half years, four meals a day : — 

First meal, 7 a. m. — A breakfast-cupful of new 
milk ; the yelk of an egg lightly boiled ; two thin 
slices of bread and butter. 



200 HYGIENE OF THE NURSERY. 

Second meal, 1 1 a. m. — A teacupful of milk with 
a soda biscuit. 

Third meal, 2 p. If. — A breakfast-cupful of beef 
tea, mutton or chicken broth ; a thin slice of stale 
bread ; a saucer of rice-and-milk pudding. 

Fourth meal, 6.30 p. m. — A breakfast-cupful of 
milk with bread and butter. 

On alternate days : — 

First meal, 7 a. M. — Two tablespoonfuls of thor- 
oughly cooked oatmeal or wheaten grits with sugar 
and cream ; a teacupful of new milk. 

Second meal, 1 1 A. M. — A teacupful of milk with 
a slice of bread and butter. 

Third meal, 2 p.m. — One tablespoonful of under- 
done mutton pounded to a paste; bread and butter, 
or mashed baked potato, moistened with good plain 
dish gravy ; a saucer of junket. 

Fourth meal, 6.30 p. m. — A breakfast-cupful of 
milk, a slice of soft milk toast, or a slice or two of 
bread and butter. 

When sickness supervenes, all that is ordinarily 
necessary is a reduction of the diet to plain milk, or 
milk with Mellin's Food. 

An important point, often neglected, is the matter 
of drink. Fven the youngest infant requires water 
several times daily, and the demand increases with 
age. The water must be as pure as possible and 
should not be too cold. In the heat of summer, 



FOOD. 201 

however, bits of ice and water moderately cooled 
by ice can be allowed without harm. 

The foregoing schedule must, of course, be 
regarded only as an average. Many children can 
bear nothing but milk food up to the age of two or 
even three years, and, provided enough be taken, 
no fear for their nutrition need be entertained. If a 
child be thriving on milk, he is never to be forced 
to take additional food merely because a certain age 
has been reached ; let the healthy appetite be the 
guide. 

A young mother, in her solicitude to do her best, 
often finds great difficulty in adhering to simple 
rules in the diet of her child. Mrs. A., who has had 
great experience with children, having had some 
herself, tells her that the child would thrive far bet- 
ter if it ate such and such a thing, and did not keep 
to weak milk foods. Miss B. assures her that her 
cousin's last child grew much healthier after eating 
a chop with vegetables and pudding each day. 
Aunt C. comes with the announcement — which she 
breaks gently — that she knows the child is simply 
starving, and the ignorant nurse confirms the state- 
ment. 

All their seemingly convincing theories are very 
upsetting to a mother who wants only to do what 
is right. She must bear in mind, however, that 
some children can eat anything and live ; but she 



202 HYGIENE OF THE NURSERY. 

does not know how much better, more robust, and 
disease-resisting they would be, did they adhere to 
a simple diet. Let her remember that the so-called 
" weak milk foods" contain those nourishing quali- 
ties to which nature, in her wisdom, has limited the 
child's powers of digestion. Therefore, young 
mothers, let well enough alone. 

d. Success in hand-feeding depends quite as much 
on the administration as upon the preparation of the 
food. 

From birth up to such time as broth, bread, and 
eggs are added to the diet, all the food should be 
taken from a bottle. Even after this, as the bottle 
is a comfort and insures slow feeding, it may be 
allowed for milk preparations, until the child, of 
his own accord, tires of it. The only feeding appa- 
ratus to be admitted to the nursery is the simple 
bottle and tip. The bottle represented in Figure 
20 is made, by my suggestion, by Mr. J. J. Otten- 
ger, of Philadelphia. Its interior surface presents 
no angles for the collection of milk ; it is easily 
cleaned, and the graduated scale is convenient for 
nursery use. 

All complicated arrangements of rubber and glass 
tubing are not only an abomination, but a fruitful 
source of sickness and death. Rather than use 
them, it is far better to feed the infant with a spoon. 
In England, a bottle with a long rubber tube is 



FOOD. 



203 



almost universally employed. Should this be aban- 
doned and a simple bottle and a rubber tip used, the 
objections of some authors to bottle-feeding would 
vanish. 



Fig. 20. 




GRADUATED NURSING BOTTLE. 



The bottle shaped as above must be of transparent 
flint glass, so that the slightest foulness can be de- 
tected at a glance, and may vary in capacity from 



204 HYGIENE OF THE NURSERY. 

six to twelve fluidounces, according to the age of 
the child. Two should be on hand at a time, to be 
used alternately. Immediately after a meal the 
bottle must be thoroughly washed out with scald- 
ing water, filled with a solution of bicarbonate or 
salicylate of sodium — one teaspoonful of either to a 
pint of water — and thus allowed to stand until next 
required ; then the soda solution being emptied, it 
must be thoroughly rinsed with cold water before 
receiving the food. The tips or nipples, of which 
there should also be two, must be composed of soft, 
flexible India-rubber, and a conical shape 
is to be preferred, as being more readily 
everted and cleaned ; the opening at the 
point must be free, but not large enough 
to permit the milk to flow in a stream 
without suction. At the end of each feed- 
ing the nipple must be removed at once 
from the bottle, cleansed externally by 
rubbing with a stiff brush wet with cold water, 
everted and treated in the same w r ay, and then 
placed in cold water and allowed to stand in a cool 
place until again wanted. 

While taking these precautions for perfect clean- 
liness, the nurse must satisfy herself of their efficacy 
by smelling both the bottle and the tip just before 
they are used, to be sure of the absence of any sour 
odor. 




EOTTLE TIP. 



FOOD. 205 

Next to cleanliness of the feeding Apparatus, it is 
important to insist upon the separate preparation of 
each meal immediately before it is to be given. The 
practice of making, in the morning, the whole day's 
supply of food, though it save trouble, is a most 
dangerous one. Changes almost invariably take 
place in the mixture, and by the close of the day it 
becomes unfit for consumption. 

When the graduated bottle is not at hand, a 
common glass graduate, marked for fluidrachms 
and ounces and holding a pint, should be provided 
for the nursery. Some moments before meal-time, 
so as to avoid hurry, measure the different fluid 
ingredients of the food in this, one after the other ; 
add the requisite quantity of milk sugar, and mix 
the whole thoroughly, by stirring with a spoon, and 
pour into the feeding bottle. When the graduated 
bottle is employed, thorough shaking is sufficient. 
The food must now be heated to a temperature of 
about 95 F. This can be done by steeping the 
bottle in hot water, or by placing it in a water-bath 
over an alcohol lamp or gas jet. Finally, apply the 
tip and the meal is ready. 

When feeding, the child must occupy a half- 
reclining position in the nurse's lap. The bottle 
should be held by the nurse, at first horizontally, 
but gradually more and more tilted up as it is emp- 
tied, the object being to keep the neck always full 



206 HYGIENE OF THE NURSERY. 

and prevent the drawing in and swallowing of air. 
Ample time, say five, ten or fifteen minutes, accord- 
ing to the quantity of food, should be allowed for 
the meal. It is best to withdraw the bottle occa- 
sionally for a brief rest, and after the meal is over, 
sucking from the empty bottle must not be allowed, 
even for a moment. 

c. For children residing in cities, an honest 
dairyman must be found, who will serve sound 
milk and cream from country cows once every day 
in winter, and twice during the day in the heat of 
summer. The milk of ordinary stock cows is more 
suitable than that from Alderney or Durham breed, 
as the latter is too rich, and, therefore, more difficult 
to digest. The mixed milk of a good herd is to be 
preferred to that from a single animal. It is less 
likely to be affected by peculiarities of feeding, and 
less liable to variation from alterations in health or 
different stages of lactation. 

The care of the herd and of the milk is of great 
consequence. The cows should be healthy, and the 
milk of any animal that seems indisposed should 
not be mixed with that from perfectly healthy 
animals. The cows must not be fed upon swill or 
the refuse of breweries, glucose factories, or any 
other fermented food. They must not be allowed 
to drink stagnant water, and must not be heated or 
worried before being milked. The pasture must be 



FOOD. 207 

free from noxious weeds, and the barn and yard 
must be kept clean. The udder should be washed, 
if dirty, before the milking. The milk must be at 
once thoroughly cooled. This is best accom- 
plished by placing the can in a tank of cold spring 
water, or in ice water, the water being of the same 
depth as the milk in the can. It is well to keep the 
water in the tank flowing; indeed, this is necessary 
unless ice water be used. The can should remain 
uncovered during the cooling and the milk should 
be gently stirred. The temperature should be 
reduced to 6o° F. within an hour, and the can must 
remain in the cold water until the time for deliver- 
ing. 

In summer, when ready for delivery, the top 
should be placed in position and a cloth wet in cold 
water spread over the can, or refrigerator cans may 
be used. At no season should the milk be frozen, 
and at the same time no buyer should receive milk 
having a temperature over 65 ° F. 

The milk and cream must be transported from 
the dairy in perfectly clean vessels. To insure this 
it is best to provide two sets of small cans ; one set 
to be thoroughly cleansed and aired while the other 
is taken away by the milkman to bring back the 
next supply. So soon as this arrives in the 
morning, or in the morning and evening in hot 
weather, the milk should be emptied into separate 



208 HYGIENE OF THE NURSERY. 

and absolutely clean earthenware or glass pitchers, 
and these put at once into a refrigerator reserved 
exclusively for them. This may stand in some 
convenient spot near the nursery, but not in it, and 
especially not in an adjoining bath room. With a 
good refrigerator there is no difficulty in keeping 
milk perfectly sweet for twenty-four hours in winter 
and for twelve hours in summer, except on intensely 
hot days ; then it may be necessary to scald, lightly 
boil or sterilize the whole of the supply when re- 
ceived, in order to prevent change. 

It is a well-known fact that milk is a fluid having 
active powers of absorption, and that it frequently 
acts as the medium of transmission of the contagion 
of such diseases as scarlatina, diphtheria and typhoid 
fever. Doctor V. C. Vaughan has also lately dis- 
covered in milk a special poison which he terms 
tyrotoxicon (cheese poison). 

The clinical elements of interest in these dis- 
coveries is the close analogy between the symptoms 
produced by the experimental use of tyrotoxicon 
and those observed in cholera infantum — an analogy 
suggestive of the possibility of the latter disease 
being chiefly due to poisoned milk. This causal 
relation is scarcely more than a theory, though 
certain well-known features of the disease seem to 
bear it out. Thus, the affection occurs at a season 
when decomposition of milk takes place most 



FOOD. 209 

rapidly ; it occurs at places where absolutely fresh 
milk cannot be obtained ; it prevails among classes 
of people whose surroundings are most favorable 
to fermentative changes ; it is most fatal at an 
age when there is the greatest dependence upon 
milk as a food, when the gastro-intestinal mucous 
membrane is most susceptible to irritants, and 
when irritation and nervous fevers are most easily 
produced. 

Drs. Newton and Wallace, of the New Jersey 
State Board of Health, have reported a number of 
cases of poisoning by milk that occurred in differ- 
ent hotels at Long Branch. These observers found 
that the affected milk w r as all obtained from one 
milkman, and that the cows furnishing it were 
milked at the unusual hours of midnight and noon. 
The noon milking was immediately placed in cans 
without being cooled, and " carted eight miles 
during the warmest part of the day in a very hot 
month. " It was this milk that produced the 
poisonous effects, the morning's milk being always 
good. No statement is made as to the health of 
the cows or the nature of the poison, but there is a 
probability of its having been tyrotoxicon, and of 
this material or its ferment having been generated 
by the careless collection and transportation of the 
milk, combined with the high atmospheric tem- 
perature. 
14 



2IO HYGIENE OF THE NURSERY. 

Childhood. — Children who have cut their milk 
teeth may be fed for a twelvemonth — namely, up to 
the age of three and a half years — in the following 
way : — 

First meal, 7 a. m. — One or two tumblerfuls of 
milk, a saucer of thoroughly cooked oatmeal or 
wheaten grits, and a slice of bread and butter. 

Second meal, 11 a.m. (if hungry). — A tumblerful 
of milk or a teacupful of beef tea with a biscuit. 

Third meal, 2 p. m. — A slice of underdone roast 
beef or mutton or a bit of roast chicken or turkey, 
minced as fine as possible ; a baked potato thor- 
oughly mashed with a fork and moistened with 
gravy ; a slice of bread and butter ; a saucer of 
junket or rice-and-milk pudding. 

Fourth meal, 7 p. If. — A tumblerful of milk and 
one or two slices of well-moistened milk toast. 

From three and a half years up the child must 
take his meals at the table with his parents, or with 
some reliable attendant who will see that he eats 
leisurely. The diet, while plain, must be varied. 
The following list will give an idea of the food to 
be selected : — 

BREAKFAST. 

EVERY DAY. ONE DISH ONLY EACH DAY. 

Milk. Fresh fish. Eggs, plain omelette. 

Porridge and cream. Eggs, lightly boiled. Chicken hash. 

Bread and butter. " poached. Stewed kidney. 

" scrambled. " liver. 



FOOD. 



211 



Sound fruits may be allowed before and after the 
meal, according to taste, as oranges, grapes without 
pulp (seeds not to be swallowed), peaches, thor- 
oughly ripe pears, cantaloupes and strawberries. 



EVERY DAY. 

Clear soup. 

Meat, roasted or 
broiled, and cut 
into small pieces. 

Bread and butter. 



DINNER. 

TWO DISHES EACH DAY. 



Potatoes, baked. 

" mashed. 
Spinach. 
Stewed celery. 
Cauliflower. 



Hominy. 
Macaroni, plain. 
Peas. 

String-beans, young. 
Green corn, grated. 



Junket, rice-and-milk or other light pudding, and occasionally ice 
cream, may be allowed for dessert. 

SUPPER. 

EVERY DAY. 

Milk. 

Milk toast or bread and butter. 

Stewed fruit. 



Fried food, highly-seasoned or made-up dishes 
are to be excluded, and no condiment but salt is to 
be used. 

Eating, however little, between meals, must be 
absolutely avoided. Keep a young child from 
knowing the taste of cakes or bonbons, or, having 
learned it, let him feel that they are as unattainable 
as the thousand other things beyond his reach, and 
he soon ceases to ask for them. Even a piece of 
bread between meals should be forbidden. His 



212 HYGIENE OF THE NURSERY. 

appetite then remains natural, and he will eat proper 
food at his regular meal hours. 

Filtered or spring water should be the only drink; 
tea, coffee, wine or beer being entirely forbidden. 

As to the quantity, a healthy child may be per- 
mitted to satisfy his appetite at each meal, under 
the one condition that he eats slowly and masti- 
cates thoroughly. 

In case of illness, the diet must be reduced in 
quantity and quality, according to the rules that are 
applicable to adults. 



DIETARY. 213 



CHAPTER IX. 

DIETARY. 

In the preceding chapter so much attention has 
been devoted to the subject of the artificial feeding 
of infants, and so many formulas have been given 
for the preparation of cows' milk as a substitute for 
the natural food, or human milk, that it will only 
be necessary here to refer briefly to a few milk mix- 
tures, some of which have been recommended by 
other writers. After describing these, the methods 
of peptonization will be discussed, and, finally, the 
mode of preparing a number of dishes adapted to 
the nursery whether occupied by well or ill chil- 
dren. In regard to the latter, however, the dishes 
that ordinarily come upon the table will not be re- 
ferred to, as any good cook ought to know how to 
make them. 

MILK FOODS. 

ARROWROOT FOOD. 

Milk, 

Cream, 
Lime water, 

Arrowroot water Of each 2 tablespoonfuls. 

Sugar 1 teaspoonful. 

This is the late Dr. J. F. Meigs' formula for a 



214 HYGIENE OF THE NURSERY. 

child of about nine months of age. The arrowroot 
water is made in the proportion of one teaspoonful 
of arrowroot to a pint of boiling water. 

CHAVASSE'S MILK FOOD. 
New milk, 

AYater, warm Of each equal parts. 

Table salt A small pinch. . 

Lump sugar . . A sufficient quantity to slightly sweeten 

the mixture. 

Let the milk and the water be of the same tem- 
perature — 90 F. — before mixing. This prepara- 
tion does well for a child of three or four months ; 
the total quantity for each meal being from eight 
to twelve tablespoonfuls. 

CONDENSED MILK. 

Condensed milk 1 teaspoonful. 

Water 6 tablespoonfuls. 

Use hot water; mix by stirring and let the 
temperature fall to ordinary heat before administra- 
tion. 

MILK AND CINNAMON". 

Milk sugar 1 teaspoonful. 

Brandy I teaspoonful. 

Milk y 2 pint. 

Powdered cinnamon A sufficiency to flavor. 

Mix thoroughly. 

Useful in diarrhoea; may be administered warm 
or cold. 



DIETARY. 2 1 5 

MILK AND OATMEAL. 
Bethlehem oatmeal (fine powder) . I teaspoonful. 

Water 2 tablespoonfuls. 

Milk 5 tablespoonfuls. 

Cream I tablespoonful. 

Sugar of milk I teaspoonful. 

Heat the water just short of boiling; stir in the 
oatmeal slowly until a smooth white mixture is ob- 
tained ; then add the other ingredients. 

This is adapted for an infant of three months, and 
forms a useful mixture in cases of constipation. 

MILK-SUGAR FOOD. 

Milk I tablespoonful. 

Cream 2 tablespoonfuls. 

Lime water 2 tablespoonfuls. 

Milk-sugar solution 3 tablespoonfuls. 

For a child under a month, quantity to be in- 
creased as age advances, but no change to be made 
in quality until after the eighth or ninth month. 

The milk-sugar solution consists of 17^ drachms 
— a little over 17 teaspoonfuls of milk sugar to a 
pint of pure water. 

This is the food recommended by Dr. A. V. 
Meigs. 

MILK AND WHITE-OF-EGG FOOD. 
The whites of three eggs. 

Lime water 3 tablespoonfuls. 

Milk . I pint. 

Shake the egg and lime water forcibly together 



2l6 HYGIENE OF THE NURSERY. 

for five minutes ; then add the milk slowly with 
constant stirring, occupying ten minutes in the pro- 
cess ; keep in a cool place. 

PEPTONIZED FOODS. 
For the process of peptonization, or predi- 
gestion, the Extractum Pancreatis, prepared by 
Fairchild Bros, and Foster, of New York, gives, 
in my experience, the most satisfactory results, 
and in all the receipts given below, this preparation 
is to be used. 

PEPTONIZED MILK, No. i. 
One peptonizing tube. 

Water I teacnpful. 

Milk, fresh and cold I pint. 

Put the powder contained in the tube into a clean 
quart bottle; add the cold water and shake well; 
then pour in the milk and shake the mixture thor- 
oughly again. Place the bottle in water of about 
1 1 5° F., or so hot that the whole hand can be held 
in it without discomfort for a minute, and keep the 
bottle there for twenty minutes. Then put the 
bottle in contact with ice to check further digestion 
and keep the milk from spoiling. 

Peptonized milk should have a slightly, but not 
decidedly, bitter taste. It may be made palatable 
by serving with grated nutmeg, sugar, or a little 



DIETARY. 217 

brandy, or it may be taken with Apollinaris or 
Vichy water. In the latter case put the water first 
into the glass, then quickly pour in the peptonized 
milk and drink while effervescing. 

PEPTONIZED MILK, No. 2. 

Mix the peptonizing powder, water and milk in 
a bottle, and place in a hot-water bath exactly as 
directed in the above. Let the bottle remain in the 
hot water for two hours, then pour into a saucepan 
and heat to boiling. This specially peptonized milk 
is used in making jellies, etc. It may be immedi- 
ately used if required hot, or set aside on ice for 
punches, etc. 

The object of raising the liquid to the boiling 
point is to abolish the activity of the pancreatin, so 
that it may not act secondarily upon other sub- 
stances prepared with the milk. 

SLIGHT PEPTONIZATION. 

Take the same ingredients and mix them as 
before, but immediately place the bottle on ice 
without subjecting it to any heat. 

This preparation is useful in cases of enfeebled 
digestive power, or as a means of returning from 
predigested, to ordinary milk. It has no especial 
taste. 



21 S HYGIENE OF THE NURSERY. 

PEPTONIZED MILK GRUEL. 
One peptonizing tube. 
Wheat flour or arrowroot . . . . I heaping teaspoon ful. 

Water, cold ]/ z pint. 

Milk, cold I pint. 

Make a smooth mixture of the arrowroot and 
water ; heat this with constant stirring until it has 
boiled briskly for three minutes ; next add the 
milk ; strain into a pitcher and stir in the pepton- 
izing powder ; let the mixture stand in the hot- 
water bath, 1 1 5 F., for thirty minutes ; then pour 
into a clean bottle and place on ice. 

PEPTONIZED MILK PUNCH. 

Fill an ordinary thin glass tumbler one-third full 
of cracked ice ; pour on it from one to four tea- 
spoonfuls, according to the child's age, of St. Croix 
rum, and a dash of Cura^oa ; add sugar to taste, and 
then fill the glass with peptonized milk ; shake well 
and grate a little nutmeg on top ; strain. 

EFFERVESCING MILK PUNCH. 

Prepare the tumbler and ice as in the above, 
squeeze in the juice of half a lemon, add sugar to 
sweeten, and fill the glass with half Apollinaris and 
half peptonized milk. The milk used in this punch 
must be prepared by the second process. 



DIETARY. 219 

PEPTONIZED BEEF TEA. 

To one-quarter of a pound of minced raw beef, 
entirely free from fat, add one-half pint of cold 
water ; cook over a slow fire, with constant stirring, 
until it has boiled a few minutes, then pour off the 
liquor and beat or rub the meat to a paste ; put the 
latter into a jar with one-half pint of cold water, and 
pour in the liquid previously obtained. Add to this 
mixture thirty grains of Extract of Pancreas and 
twenty grains of bicarbonate of sodium ; shake all 
well together, and keep at a temperature of about 
1 io° F., stirring occasionally, for three hours. Next 
boil quickly, strain, and serve as required. 

PEPTONIZED OYSTERS. 

(Originally suggested by the late Dr. N. A. Randolph.) 

Take half a dozen large oysters with their juice 
and half a pint of water. Heat in a saucepan until 
they have boiled briskly for a few minutes. Pour 
off the broth and set aside. Mince the oysters fine 
in a wooden bowl, and reduce them to a paste with 
a potato masher. Next put the oysters in a glass 
jar with the broth which has been set aside and 
add the contents of a peptonizing tube. Let the jar 
stand in hot water or in a warm place, where the 
temperature is not above 1 1 5 ° F., for one and a half 
hours. Next pour into a saucepan and add half a 
pint of milk ; heat over the fire slowly to boiling 
point, and flavor with salt to taste, and serve hot. 



220 HYGIENE OF THE NURSERY. 

"HUMANIZED MILK." 

Peptogenic milk powder I measure.* 

Milk, fresh and cold 4 tablespoonfuls. 

Water 4 tablespoonfuls. 

Cream I tablespoonful. 

Heat cautiously over a flame for six minutes, 
stirring cautiously with a spoon and tasting often, 
so that it shall not get too hot to be sipped — 115 
F. Then put into a nursing bottle, let it cool some- 
what, and it is ready for administering. The cup 
should be held by the hand, over the flame, thus 
making it easy to regulate the heat to which the 
milk is exposed. 

It is important to follow out these directions abso- 
lutely, for should the temperature of the mixture 
not be maintained at a sufficiently high point, the 
Pancreatin contained in the peptogenic powder 
will perform its work imperfectly ; on the other 
hand, should the heat be too great all digestive 
activity will be suspended. 

Humanized milk so prepared is adapted to the 
average infant's digestion. As age advances, the 
proportion of milk must be increased and the total 
quantity of the mixture augmented. As an increase 
in quantity is made, it is necessary to preserve the 
relations of the peptogenic powder to the liquid; 
namely, one measure to each four ounces and a half. 

* The proper measure is furnished with each box of powder. 



DIETARY. 221 

Sometimes it will be found necessary to carry the 
process of predigestion further than can be accom- 
plished by following the directions already given. 
This may be readily done by increasing the length of 
the time of heating. One can thus easily produce in 
the milk any degree of change up to complete pep- 
tonization, when the liquid becomes clear and very 
bitter. Conversely, when it is desirable — in case of 
returning health, for instance — to resume a plain 
milk diet, the time of heating is gradually shortened 
until the powder is added to the milk mixture just 
at the time of feeding. When the time comes to 
abandon the digesting powder entirely, it is most 
important to supply its place in the food by an 
equal bulk of milk sugar. 

The milk and cream referred to are of such qual- 
ity as can be obtained from a reliable city server ; 
extra rich milk or cream may, under some circum- 
stances, require to be more diluted. 

MEAT BROTHS, ETC. 
BEEF TEA, No. i. 

Take one pound of lean beef and mince it; put 
it, with its juice, into an earthen vessel containing 
a pint of clear water at a temperature of 85 ° F., 
and let the whole stand for one hour. Strain well 
through stout muslin, squeezing all juice from the 
meat; place on the fire, and, while stirring briskly, 



222 HYGIENE OF THE NURSERY. 

slowly heat the liquid just to the boiling point. 
Then remove at once and season with salt. 

When administering this, be careful to stir up 
whatever sediment may be present. 

BEEF TEA, No. 2. 

Take half a pound or a pound — according to 
strength required — of rump steak ; cut it into small 
pieces ; free it completely from fat and tendon, and 
put it, with one pint of clear, cold water, into a cov- 
ered saucepan. Place by the side of the fire for five 
hours ; then let it simmer gently for two hours, and 
finally skim thoroughly. The meat used should 
be as fresh as possible, and the saucepan should 
be of copper or tin, or be enameled on the inner 
surface. 

Beef tea must never be allowed to boil, and in 
reheating be careful to raise it only to the proper 
point for drinking. 

BEEF TEA IN FIFTEEN MINUTES. 

Scrape one pound of lean beef into fibres, and, 
after placing it in a clean saucepan, pour on half a 
pint of boiling water; then cover the saucepan 
closely, and place it by the side of the fire for ten 
minutes; next strain into a teacup; place this in a 
basin of ice-cold water and remove all fat from the 
surface of the liquid, first with a spoon and finally 
with a piece of stale bread or blotting paper ; then 



DIETARY. 223 

pour into a warm cup and heat gently to the tem- 
perature for drinking. 

BEEF ESSENCE, No. 1. 

Thoroughly mince one pound of rump steak ; 
place it with three tablespoonfuls of water in a mor- 
tar ; pound it well and put it aside to soak for two 
hours. Then put it, with a pinch of salt, in a cov- 
ered earthen jar; cement the edges of the cover 
with dough and tie a piece of cloth over the top. 
Place the jar in a pot half full of boiling water, and 
keep the whole on the fire, simmering, for four 
hours. Then, through a coarse sieve, strain off 
the liquid essence, which will amount to about six 
ounces. 

One teaspoonful will be sufficient for a young 
child. 

BEEF ESSENCE, No. 2. 

Half a pound of fresh beef must be minced as 
finely as possible ; add to this half a pint of pure 
cold water, an eggspoonful of salt and five drops of 
pure muriatic acid. Mix well, and after standing 
an hour, pass through a conical sieve without pres- 
sure, refiltering until the liquid runs clear. Next, 
a second half pint of water is poured on the residue 
upon the sieve and allowed to filter through with- 
out pressure. 

The dose of this is two tablespoonfuls for a child of 
twelve years, a teaspoonful for one under one year. 



224 HYGIENE OF THE NURSERY. 

RAW-BEEF JUICE. 

Take one pound of sirloin of beef; warm it in a 
broiler before a quick fire; cut into cubes of about 
one-quarter of an inch, and after placing in a lemon 
squeezer or meat press, forcibly express the juice; 
remove the fat that rises to the surface after cooling. 

This may be given warm or cold, and seasoned 
with a little salt, in doses of one teaspoonful every 
two hours to a child of six months to a year old. 

The meat must never be actually cooked. 

RAW BEEF. 

Cut a tenderloin beefsteak into the finest possible 
pieces and free it as nearly as may be from particles 
of fat ; then place in a mortar and pound until the 
meat becomes pulpy ; next rub through a fine sieve 
and season w 7 ith salt and a little black pepper. 

A teaspoonful of this pulp three or four times 
daily will be sufficient for a child of one year old. 

CLEAR BROWN SOUP. 

Cut a shin of beef into pieces ; put it into a sauce- 
pan with just enough water to cover it; when it 
boils, skim it, and add a bundle of sweet herbs, a 
little turnip, carrot, onion and celery, and a little 
pepper and salt. Let the whole boil until the meat 
is quite tender ; then strain, and let it stand until 
the next day. After clearing it thoroughly from 
fat, heat it again, adding as much browning as will 



DIETARY. 225 

make the soup the color you like. Beat up two 
eggs, with their crushed shells, till they are quite 
a froth. Put them into the soup with a whisk; let 
it boil gently for ten minutes ; then strain it through 
a cloth, and it will be perfectly bright. (Dr. Ellis.) 

CONSOMMfc. 

Make a beef broth by taking one or two pounds 
of beef, according to the strength required, from 
the leg, round or chuck ; wash well ; cut in pieces 
and put on to boil in three quarts of cold water. 
While boiling, skim frequently, and when reduced 
to one quart, take from the saucepan and strain ; after 
which return to the saucepan with a few thin slices 
of onion, and half a pound of lean beef, chopped 
fine, and well mixed with three raw eggs ; beat all 
thoroughly with the broth, which is to be returned 
to the fire and boiled for about half an hour, or 
until perfectly clear. 

CHICKEN BROTH. 

A small chicken, or half of a large fowl, thor- 
oughly cleaned, and with all the skin and fat 
removed, is to be chopped, bones and all, into small 
pieces ; put these, with a proper quantity of salt, 
into a saucepan and add a quart of boiling water ; 
cover closely and simmer over a slow fire for two 
hours ; after removing, allow to stand, still covered, 
for an hour, and strain through a sieve. 
15 



226 HYGIENE OF THE NURSERY. 

MUTTON BROTH. 
Lean loin of mutton . . I pound (exclusive of boneV 
Water 3 pints. 

Boil gently until very tender, adding a little salt 
or onion, according to taste; strain into a basin, 
and, when cold, skim off all the fat. Warm, when 
served. 

Should barley or rice be added, they must be 
first separately and thoroughly boiled, and added 
when the broth is heated for use. 

VEAL BROTH. 
Lean veal . . . . . . y 2 to 1 pound, according to 

strength required. 
Cold water I pint. 

Mince the meat; pour upon it a pint of cold 
water; let it stand for three hours; then slowly 
heat to boiling point, and after boiling briskly for 
two minutes, strain through a fine sieve and season 
with salt. 

OYSTER SOUP. 

Drain one pint of oysters through a colander for 
five minutes, to remove the liquor, and then pour 
over them one pint of boiling water, which must be 
thrown aside; add to the liquor already drained a 
pint of boiling water and put over the fire in a porce- 
lain-lined saucepan. Boil until all the scum has 
risen and been skimmed off; then add half a pint 
of fresh milk, one water cracker rolled to a powder, 



DIETARY. 227 

a piece of butter, and a little salt and pepper ; boil 
ten minutes, and just before the soup is to be served 
turn in the oysters from the colander and let them 
scald for three minutes. 

ARROWROOT PUDDING. 

Mix a tablespoonful of arrowroot with cold water ; 
put it over the fire in a porcelain-lined saucepan ; 
add a pint of boiling milk — stirring constantly — and 
one egg well beaten with a tablespoonful of white 
sugar ; let it boil five or ten minutes. 

If baked pudding be preferred, it may be mixed 
in the same way and baked, in a moderately quick 
oven, for twenty or thirty minutes. 

BLANC MANGE. 

Gelatine ]/ z ounce. 

Water x / 2 pint. 

Cream 1 pint. 

White sugar 3 ounces. 

Extract of lemon Sufficient to flavor. 

Dissolve the gelatine in the water by means of 
heat, meanwhile whipping the cream and sugar 
together and adding the lemon. Next, while the 
gelatine solution is still warm, pour in the cream 
slowly, and beat until stiff enough to drop from the 
spoon ; finally pour in moulds. 

Milk may be used instead of water in this prepa- 
ration. 



228 HYGIENE OF THE NURSERY. 

HOMINY GRITS. 

Twotablespoonfuls of hominy, having been boiled 
soft, are rubbed up with butter until quite light; 
then, half a pint of boiled milk is added slowly, with 
constant stirring ; next strain through a sieve and 
boil again ; flavor with sugar or salt, and serve hot. 
Rice may be prepared in the same way. 

JUNKET. 
Milk I pint. 

Essence of pepsin (Fairchild's) . . 2 teaspoonfuls. 

(Wine of pepsin or liquid rennet may also be used.) 

Heat the milk just to a temperature that can be 
readily borne in the mouth, and add, with gentle 
stirring, the curdling agent; allow to stand until 
firmly curded, and serve with sugar, nutmeg, or 
cream as desired. 

JUNKET WITH EGG. 

A good custard may be made by adding two 
eggs, beaten to a froth and sweetened with four 
teaspoonfuls of sugar, to the pint of milk, and then 
curdling with essence of pepsin. It is well to pour 
this, when prepared, into coffee cups, one of which 
will be enough to serve at a time. 

MILK AND GELATINE. 

Gelatine I tablespoonful. 

Barley water, hot x / 2 pint. 

Powdered sugar 2 tablespoonfuls. 

Milk I pint. 

Dissolve the gelatine in the hot barley water; 



DIETARY. 229 

add the sugar, and then the milk ; stirring all to- 
gether. 

RICE-MILK. 

Rice 2 tablespoonfuls. 

Corn starch 1 teaspoonful. 

Milk 2 pints. 

Boil in a farina boiler until each grain of the 
rice becomes saturated, and the whole creamy 
in color. 

RICE PUDDING. 

Take three ounces of rice, and swell it very gently 
in one pint of new milk. Let it cool ; then stir into 
it one ounce of fresh butter, two ounces of pounded 
sugar, the yelks of three eggs, and some grated 
lemon rind. Pour this into a well-buttered dish, 
but do not quite fill it, and then lay lightly over 
the top the whites of three eggs which have been 
well beaten up with three tablespoonfuls of sifted 
sugar. Put the pudding directly into the oven, the 
heat of which must be moderate, and bake it for 
about twenty minutes, or till the egg crust has 
become lightly browned. 

OATMEAL GRUEL. 

Mix a large tablespoonful of oatmeal with two 
tablespoonfuls of cold water, stirring to bring to a 
state of uniformity ; this pour into a pint of boiling 
water in a saucepan, and boil and stir well for ten 
minutes. Flavor with salt or sugar. 



23O HYGIENE OF THE NURSERY. 

If the boiling be continued for half an hour, the 
mixture thickens into a porridge. 

SAGO JELLY. 

Take two tablespoonfuls of sago ; wash carefully ; 
soak for four hours in a half pint of cold water, and 
then add half a pint of hot water, a pinch of salt, a 
tablespoonful of sugar and a little grated lemon 
peel ; boil gently fifteen minutes, stirring constantly. 
A little port wine or sherry may be added just 
before removing from the fire. 

May be served hot or cold. 



TAPIOCA. 

Wash two tablespoonfuls of the best tapioca ; 
soak in fresh water over night ; add a little salt, a 
pint of milk or water, and simmer until quite soft, 
stirring frequently if milk be used ; then pour into 
a bowl and stir while cooling, at the same time 
adding sugar, some flavoring substance and wine 
if required. 

TAPIOCA PUDDING. 

Beat the yelks of two eggs with half an ounce of 
sugar; stir into a pint of tapioca mucilage made 
with milk, as directed above, and bake in a slow 
oven. 

EGG-AND-BRANDY. 
Brandy 8 tablespoonfuls. 

Cinnamon water 8 tablespoonfuls. 

The yelks of two eggs. 

White sugar 1 tablespoonful. 



DIETARY. 231 

Rub the yelks and sugar together ; then add the 
cinnamon water and spirit. 

A dessertspoonful to two tablespoonfuls may be 
given every two hours, according to the age of the 
child. 

WINE WHEY. 

Boil a pint of fresh milk ; while boiling, pour in 
eight tablespoonfuls of sherry wine ; bring it to the 
boil a second time, being careful not to stir it ; so 
soon as it boils, put it aside until the curd settles, 
and pour off the clear whey. 

FLAXSEED TEA. 
Whole flaxseed I ounce. 

Bruised licorice root ....'* # . 2 teaspoonfuls. 

Water, boiling , . I tablespoonful. 

Pour the boiling water over the flaxseed and lico- 
rice ; cover lightly ; digest for three hours near a 
fire, and strain. Two tablespoonfuls of lemon juice 
may be used as the flavor, instead of the licorice. 

The following preparations are useful as additions 
to milk in bottle feeding : — 

CARAWAY WATER. 

Caraway seeds, crushed 2 tablespoonfuls. 

Water 1 pint. 

Enclose the seeds in a small muslin bag, and boil 
in the water until the latter is reduced to half a pint. 

One or two teaspoonfuls may be added to the 
bottle in case there be colic. 



232 HYGIENE OF THE NURSERY. 

BARLEY WATER. 

Put two teaspoonfuls of washed pearl barley into 
a saucepan with a pint of clear water, and boil 
slowly down to two-thirds of a pint ; strain through 
muslin. 

Employed to prevent the formation of large, com- 
pact curds. 

GELATINE. 

Put a piece of plate gelatine, an inch square, into 
half a tumblerful of cold water, and let it stand for 
three hours ; then turn the whole into a teacup, 
place this in a saucepan half full of water, and boil 
until the gelatine is dissolved. When cold, this 
forms into jelly. 

From one to two teaspoonfuls may be added to 
each bottle of milk food. 

Employed for same object as the above. 

FLOUR BALL. 

Take a pound of good wheat flour — unbolted, if 
possible — tie it up very tightly in a strong pudding- 
bag ; place it in a saucepan of water and boil con- 
stantly for ten hours ; when cold remove the cloth; 
cut away the soft outer covering of dough that has 
been formed, and reduce the hard, baked interior 
by grating. 

In the yellowish-white powder obtained, almost 
all the starch has been converted into dextrine by 
the process of cooking, and the proportion of the 



DIETARY. 233 

nitrogenous principle to the calorifacient is as one 
to five — nearly the same as in human milk. 
This acts both mechanically and as a food. 

LIME WATER. 

Take a piece of unslaked lime as large as a wal- 
nut ; drop it into two quarts of filtered water con- 
tained in an earthen vessel ; stir thoroughly ; allow 
to settle, and use only from the top ; replacing the 
water, and stirring as consumed. 

OATMEAL WATER. 

First prepare an oatmeal porridge ; take a heap- 
ing teaspoonful of this, put it into a quart of cool 
water, heat, with constant stirring, to the boiling 
point, and strain. 

This may be used in milk-foods as a substitute 
for ordinary water if constipation be present. 

PEARL BARLEY JELLY. 

Put two tablespoonfuls of washed pearl barley 
into a quart saucepan with a pint and a half of clear 
water and boil slowly down to a pint ; strain, and 
allow the liquid to set into a jelly. 

Used for same purpose as barley water. 

RICE WATER. 

Put two tablespoonfuls of rice, thoroughly washed, 
into a quart of water and place near the fire, where 



234 HYGIENE OF THE NURSERY. 

it may soak and be kept warm for two hours ; then 
boil slowly for one hour, or until the water is re- 
duced one-half, and strain. 

Useful as a diluent for milk in cases of diarrhoea. 

WHEY. 

Milk I pint. 

Essence of pepsin (Fairchild's) . . 2 teaspoonfuls. 

Heat the milk up to a point that can be agree- 
ably borne by the mouth, and add the pepsin with 
gentle stirring ; let the whole stand until firm co- 
agulation has taken place ; then beat with a fork 
until the curd is finely divided, and strain. 

NUTRITIOUS ENEMATA. 

The process of peptonization, already described, 
is very useful in the preparation of food for absorp- 
tion by the lining membrane of the rectum. Any 
of the predigested foods may be used in this way, 
the only caution being to administer them in small 
quantities — not over four tablespoonfuls — and at 
intervals of not less than four hours. It is essential, 
too, in rectal feeding to keep the lower bowel clear 
by a daily laxative injection of warm water. 

When the materials for proper peptonizing are 
not at hand, one of the following enemata may be 
used with advantage : — 



DIETARY. 



235 



MEAT ENEMA WITH PEPSIN. 

Essence of meat, No. 2 8 tablespoonfuls. 

Gelatine (page 174) I tablespoonful. 

Pepsin 4 grains. 

Muriatic acid 4 drops. 

First mix the essence and gelatine, and warm in 
a water bath at 11 2° F. ; then dissolve the pepsin 
in a teaspoonful of warm water by 
the aid of the acid ; stir it into the 
first mixture and let the whole re- 
main warm for two hours. 

Administer warm with two drops 
of laudanum to secure retention. 

The bulk of this enema is adapted 
for a child of eight to twelve years. 



Fig. 22. 



BEEF-TEA AND BRANDY ENEMA. 
Strong beef tea . .3 tablespoonfuls. 

Cream I teaspoonful. 

Brandy 1 teaspoonful. 

Stir all together, and administer 
gently and slowly. 

Should this injection not be re- 
tained, add two drops of laudanum syringe for nutri- 

' r TIOUS ENEMATA. 

at each administration. 

The best syringe for these injections is shown in 
Fig. 22. 




36 HYGIENE OF THE NURSERY. 



CHAPTER X. 

MASSAGE. 

Systematic manipulation is of great value both as 
a means of preserving health and as a scientific 
method of treating certain diseases in children. 

Mere rubbing or friction of the surface cannot be 
included under massage in its literal sense, still, it 
is a useful form of manipulation, and needs no spe- 
cial instruction, being possible to any intelligent, 
soft-handed mother or nurse. 

Massage, on the contrary, is an art, and, like every 
other art, requires study and patient preparation for 
its successful practice. It is a powerful remedy, too, 
and, like other agents of its class, as potent for evil 
as for good in unskilled hands. Therefore, to insure 
good results, a trained masseuse is necessary — and 
she must act under the direction of the physician. 

Massage includes several processes of manipula- 
tion. Those given by Murrell, from whose excel- 
lent little work* I have taken much of the descrip- 
tion of the different " movements," are efflenrage, 
petrissage \ friction and tapotement. 

* " Massage as a Mode of Treatment." W. Murrell. 



MASSAGE. 237 

Effleurage is a stroking movement made with the 
palm of the hand passing with more or less force 
over the surface of the body centripetally. The 
movements are made to follow as nearly as possible 
the direction of the muscle fibres, and for deep- 
seated tissues the knuckles can be used instead of 
the palm. This method is of minor value in itself, 
but of great use when combined, as is the rule, with 
the procedures to be described. 

Petrissage consists essentially in picking up a 
portion of muscle or other tissue with both hands, 
or the fingers of one hand, and subjecting it to firm 
pressure, at the same time rolling it between the 
fingers and the subjacent tissues. The hands must 
move simultaneously and in opposite directions, the 
skin must move with the hands to avoid giving 
pain, and the thumb and fingers must be kept wide 
apart in order to grasp a bulk of tissue, a whole 
muscle belly, for instance. The manipulation must 
be uniform, in a direction from the extremities 
toward the centre of the body, bearing in mind the 
arrangement of groups of superficial muscles and 
keeping well in the spaces between them. 

Friction, or massage a frictions, is performed 
with the tips of the fingers. It is a pressure move- 
ment rather than a rubbing. It is always associated 
with effleurage, and, to be of any use, must be per- 
formed quickly and readily. 



238 HYGIENE OF THE NURSERY. 

Tapotement is a percussion which may be made 
with the tips of the fingers, their palmar surfaces, 
the palm of the hand, the back of the half-closed 
hand, one or other border of the hand, or with the 
hand partly closed, so as to contain, when brought 
in contact with the surface of the body, a cushion 
of air. 

The hand of the masseuse must be perfectly clean 
and soft, and the finger-nails short and smooth. 
The length and frequency of the sittings must vary 
with the individual case. Murrell is in favor of 
short and frequent seances, and also recommends 
dry massage, that is, without the use of oil, lini- 
ments or ointments ; vaseline especially is to be 
avoided. 

Our knowledge of the physiological action of 
massage is based upon experimental research and 
clinical experience. Experiments were made by 
Dr. Gopadze (quoted by Murrell) upon four medi- 
cal students, who were kept in hospital and sub- 
jected to systematic manipulations for twenty 
minutes or more daily. The seance began with 
effleurage, followed by petrissage, friction and 
tapotement, and ending with a second effleurage. 
The results were increased appetite and a notable 
gain in body weight. The body temperature fell, 
never more than .5°, for about thirty minutes after 
each massage; then it rose steadily, and an hour 



MASSAGE. 239 

later was generally a degree higher than at the 
commencement of the operation. The movements 
of breathing were uniformly increased in frequency, 
depth and fulness. The pulse varied with the kind 
of " movement " used — light surface effleurage in- 
creased its frequency, while petrissage made it 
slower. 

Zabludowski, experimenting on himself and two 
servants for eighteen days, noted increased bodily 
and mental vigor and improved appetite and sleep. 

Clinical experience shows that massage increases 
the activity of the circulation, reddens the skin and 
elevates the temperature in the part manipulated. 
It also increases the electrical contractility of mus- 
cular tissue, and stimulates the flow of lymph in 
the lymphatic vessels. Muscular stiffness and 
fatigue are relieved, nervous irritability is calmed, 
and restless and wakeful patients are soothed by it 
into refreshing sleep. 

With these facts at hand, it is not difficult to see 
what a useful agency we possess in skillfully em- 
ployed massage. By its application we have the 
power to prevent the wasting of muscles and to 
augment muscle strength, to build up such tissues 
as fat and blood, to improve nerve force, both 
directly by producing a better blood supply and 
indirectly by relieving irritability and giving rest 
and sleep, and, finally, to hasten the absorption of 



24O HYGIENE OF THE NURSERY. 

waste tissue and of morbid effusions. At the same 
time it must always be remembered that massage 
is a powerful remedy. A short seance with gentle 
movements may do good in infantile palsy, for ex- 
ample, but it does not follow that by doubling the 
time or force, twice as much benefit will be derived. 
In fact, the reverse of the proposition is true ; short, 
gentle massage maintains the size and strength of 
the muscles, while long, forcible manipulation 
causes them to waste quickly. The same truth 
runs through the whole question and must be 
observed. 

Before entering upon the therapeutic application 
of massage proper, it will be well to revert to the 
process of simple rubbing, already mentioned. 
This is of much value as a general hygienic mea- 
sure. Each day, after the bath, the skin having 
been thoroughly dried by a soft, warm towel, the 
whole surface should be gently rubbed with the 
palm of the hand, the process occupying about five 
minutes. This increases the circulation in the 
minute blood-vessels, encourages thorough reac- 
tion, aids nutrition and adds vigor to the frame. 
Weakly children especially thrive under it. In 
older children, friction with a soft towel may be 
substituted for hand-rubbing, but this change should 
not be made before the fifth or sixth year. 

Sometimes it is well to rub certain portions of 



MASSAGE. 24I 

the body more thoroughly than others. Thus in 
rickets the spine should receive especial attention, 
in indigestion and constipation the abdomen, in 
weak ankles the feet and legs, etc. ; though even 
in these cases the general surface must receive a 
share. 

Massage may be employed with advantage in the 
following diseases of childhood : — 

(a) Long-standing stomach or intestinal indiges- 
tion (chronic gastro-intestinal catarrh). In this 
condition the skin is harsh, and often so dry that 
a shower of dead scales falls from the surface on 
the removal of the underclothing, the muscle tone 
is faulty, general nutrition is impaired, and there is 
a determination of blood from the surface toward 
the mucous membranes. To get the skin active, 
and in this way balance the circulation, is an im- 
portant step in the reestablishment of normal diges- 
tion, secretion and excretion, the essentials of per- 
fect nutrition. To accomplish this, a full, warm 
bath is administered every evening, just before 
bedtime, the patient remaining in the water for five 
minutes. Then the surface is thoroughly dried, and 
half an ounce of olive oil is gently rubbed into the 
skin (inunction), the child enveloped in a light 
blanket and put to bed. After a little time sweat- 
ing begins. So soon as the sweating is free the 

skin is again dried and the night-dress put on in 
16 



242 HYGIENE OF THE NURSERY. 

preparation for sleep. Next morning, at some 
convenient time after breakfast, the child is sub- 
jected to twenty minutes' massage (petrissage with 
effleurage). The inunctions are continued until the 
skin becomes soft and active, and massage is em- 
ployed daily until there is a decided improvement 
in the amount of flesh and general strength — a 
period generally of two or three weeks. After- 
ward, M movements n every third day will be suffi- 
cient to complete the cure. 

In these cases massage not only aids the baths 
and inunctions in their general action, but directly 
and powerfully increases nutrition and muscle force, 
and materially hastens an otherwise slow process 
of recovery. 

{b) Constipation. Manipulation is a very effi- 
cient remedy in habitual constipation, and there 
are many cases that can be cured by it, combined 
with a properly regulated diet, without the use of 
drugs. Petrissage of the large intestine is the best 
method, instructions being given to follow the natu- 
ral course of the faeces through this portion of the 
gut ; thus, beginning in the right groin to proceed 
upward to the lower border of the ribs on the right 
side, to cross over, horizontally, to the same region 
on the left side, and then downward to the left groin. 
In this way the ascending transverse and descend- 
ing colon are manipulated in order. 



MASSAGE. 243 

Five or ten minutes every morning, or every 
morning and evening in obstinate cases, constitute 
the proper duration and frequency of the applica- 
tions. The pressure must be gentle, as delicate 
underlying tissues are being dealt with. 

In this condition I have not found the dry method 
so efficient as a combination of massage with the 
inunction of warm olive oil. 

Sometimes tapotement with the flat hand, the 
hand partly closed forming a cushion, or with the 
margin of the hand, is necessary, but the course of 
the colon must always be followed. The beneficial 
action of this mode of treatment is, undoubtedly, 
threefold : it increases the intestinal and other se- 
cretions ; it increases the expulsive action of the 
intestinal muscular fibres, and it mechanically forces 
accumulated faecal matter toward the natural gate 
of exit. 

(c) Colic. Every experienced mother knows how 
often "wind," the cause of colicky pain, is expelled 
from the stomach or intestines by gently rubbing 
the abdomen with the hand. Any approach to 
scientific manipulation is much more efficient, and 
two or three minutes' effleurage may be resorted 
to, as the urgency of the symptoms requires, with 
the most satisfactory effect. In this connection it 
must be remembered, also, that rubbing of the feet 



to inc: aicnl ition is an important aid in 

debility and impoverished blood. 
7 re much benefited by short, 

epeated cour igc In the 

convalescence from m^ e — both acute and 

chroni: — the above conditions are present, and 
manipulation, by improving general nutrition, leads 
to a rapid restoration of strength. 

Infantile paralysis. Here massage erf* the 
paralyzed muscles brings more blood into them 
and mair. their nutrition until, in favorable 

ef r.e 
which have been destroyed. 

In infantile paralysis the afiected members are 
cold, and the muscles : ontract feebly, if at 
under the influence of electricity. By system- 
atic ma — petrissage combined with effleurage 
] both performed centripetally---an improvement 
take rapidity. The fiist 
indication of this is an increi the temperature 
the parts, contir everal hours after the 
rubbing. Then the electrical contractility of the 
to return, and they respond to a 
ba. the commencement 
entirely inope 

In recent cases th should be of short 



MASSAGE. 245 

duration and frequently repeated, five to ten min- 
utes, three or four times daily. As improvement 
advances, the frequency may be reduced, and in 
chronic cases twice a day will be sufficient at any 
time. 

Electricity is of great aid in the treatment, but it 
does not take the place of massage, for while it 
causes contraction and congestion of the muscles 
and an accumulation of blood in the skin, it does 
not have the same power of arresting rapid 
wasting. This branch of the treatment should 
never be undertaken without the counsel of a phy- 
sician. 

(/) St. Vitus's dance (chorea). So far as this 
branch of the management of chorea is concerned, 
it requires to be aided by proper diet and rest in 
bed. On the onset of an acute attack the patient 
is put to bed, given a full supply of good food and 
allowed to rest for two days without massage. 
Should the jerking movements be very violent, the 
sides of the bed are padded to prevent the child 
bruising himself, or, if too violent for this, to give 
security, he is slung in a hammock. 

At the end of this time the regular treatment is 
initiated. The child — at seven years of age, for 
example — has, at 5.30 A.M., half a pint of warm 
milk ; 7 A. m., half a pint of milk and three slices of 
bread and butter (each slice an ounce in weight); 



246 HYGIENE OF THE NURSERY. 

9.45 a.m., a teaspoonful of Horlick's dry malt in a 
little milk; 10 a.m., massage for fifteen minutes, 
followed by half a pint of warm milk; 12.30 p.m., 
a teacupful of rice pudding, half a pint of milk, 
green vegetables and mashed potatoes; 4.15 p.m., 
half a pint of warm milk, three slices of bread and 
butter and a lightly boiled egg; 7 p.m., malt as 
before; 7.30 p.m., massage for fifteen minutes, fol- 
lowed by half a pint of milk. At the end of ten 
days or a fortnight, the bread and butter is increased 
to four slices at 7 a. m. and 4. 1 5 p. if. ; a lean broiled 
chop is added to the mid-day meal, and an extra 
pint of milk is distributed over the twenty-four 
hours. After two or three weeks the patient may 
be allowed to sit up in bed, well supported by pil- 
lows, and may have a few toys to play with. It is 
a golden rule, however, never to hurry a patient 
with chorea out of bed. The muscular strength is 
more quickly recovered while at perfect rest, and 
too early exertion often causes a relapse. While 
carrying out this plan appropriate medical treat- 
ment should be employed. 

(g) Among other nervous diseases in which 
massage is practiced with success are facial par- 
alysis; neurasthenia and spinal irritability occurring 
in girls about the approach of puberty, and that ill- 
defined and painful condition so often encountered 
in young subjects and known as " growing pains." 



MASSAGE. 247 

(Ji) Accumulations of watery fluid between the 
lungs and the chest wall (pleuritic effusions) ; en- 
larged glands, and stiffened rheumatic joints are all 
benefited by rubbing. In these special instances 
the manipulations are generally combined with the 
use of ointments or lotions, though the curative 
effects cannot be attributed to the latter alone. 

In concluding the subject of massage in child- 
hood, it is a point of importance to mention that 
those cases in which the manipulation is imme- 
diately followed by a sensation of comfort or by 
refreshing sleep are most benefited by it. On the 
contrary, those cases that are stimulated, derive 
little benefit, and perhaps positive injury from rub- 
bing. This I have especially noted in cases of gen- 
eral debility and impoverished blood, and my own 
experience has been confirmed by a number of 
practical observers in whose judgment I have the 
greatest confidence. 



248 HYGIENE OF THE NURSERY. 



CHAPTER XL 

EMERGENCIES. 

In the first Chapter, attention was directed to 
certain deviations from the features of health that 
should lead the mother or nurse to suspect the 
onset of disease. In addition to these, it is of great 
service to take into account the four seasons of the 
year, and to be informed of what diseases are most 
apt to prevail during each. 

In the late fall and early winter catarrhal affec- 
tions are most apt to occur. In catarrh there is 
an increased secretion of mucus from the lining 
membrane of either the nose, the throat, the air- 
tubes or the digestive canal, attended by fever, loss 
of appetite, thirst and lassitude, with sneezing, 
hoarseness, cough, vomiting or diarrhoea, accord- 
ing to the situation of the disease. 

As winter advances, the bronchial tubes, the 
lungs themselves and their investing membrane — 
the pleurae — are liable to attack, and the signs of 
bronchitis, pneumonia or pleurisy to be developed. 

In the changeable weather* of spring, together 
with the catarrhal and inflammatory disorders al- 
ready mentioned, epidemics of measles, scarlet fever 



EMERGENCIES. 249 

and chicken pox are most prevalent ; while during 
the summer months, disorders of the bowels, such 
as diarrhoea, summer complaint and cholera infan- 
tum, swell the mortality lists of the larger cities. 

Again, the influence of any hereditary tendency 
to disease should always be present in the mother's 
mind, as this not only makes her alive to the possi- 
bility of the onset of illness and leads her to seek 
medical advice in time, but also induces her to 
shield anxiously her child from known exciting 
causes, and to adopt hygienic measures calculated 
to overcome the constitutional predisposition. 

In considering the question of emergencies, un- 
der which term will be included both accidents and 
certain conditions of disease, no reference will be 
made to the management of serious disorders. 
These, even in their earliest stages, must receive 
the attention of a physician. 

ACCIDENTS AND DISORDERS OCCURRING AT BIRTH 
OR SOON AFTER. 

INJURIES RECEIVED DURING BIRTH. 

The shape of the head is sometimes altered by 
the compression it is subjected to during a pro- 
longed and difficult labor. The deformity is usu- 
ally in the direction of elongation. The distance 
from the chin to the back of the head at times 
measuring six inches or even more. There is no 



25O HYGIENE OF THE NURSERY. 

ground for apprehension in these cases, and the 
head will regain its natural shape without mechani- 
cal interference. 

Swellings upon the scalp are quite common. 
They are due to pressure sustained by the parts in 
labor. Such tumors gradually subside, if kept free 
from compression and frequently bathed with cool- 
ing lotions ; of the latter, alcohol and water, the 
extract of witch-hazel and water, or diluted lead 
water are serviceable. 

The face may be congested and blackened, and 
the features disfigured and distorted from the same 
cause. A natural appearance, however, will be 
recovered in a few days without any treatment. 

BLEEDING FROM THE NAVEL STRING. 

This serious accident occasionally occurs some 
hours after birth. It arises from the cord being 
carelessly tied or from its being unusually large at 
birth, and subsequent shrinking so that the ligature 
ceases to close the blood vessels. 

To arrest the hemorrhage, the infant's clothes 
and flannel binder must be removed and the cord 
exposed; then a new ligature, composed of six 
strands of strong linen thread, must be applied half 
an inch nearer the body than the original one, and 
tied tight enough to compress thoroughly the ves- 
sels, but not so tight as to cut through the cord. 



EMERGENCIES. 25 I 

ULCERATION OF THE NAVEL. 

The cord generally separates from the navel 
between the fifth and fifteenth day after delivery, 
and the parts should then heal without trouble. 
Occasionally, after the falling of the cord, a small 
growth, about as large as a pea, appears on the 
navel, giving rise to a discharge of thin liquid. This 
may be relieved by applying a little powdered alum 
and afterward dressing with vaseline or oxide of 
zinc ointment. 

Again, though rarely, excoriation of the navel 
and surrounding skin takes place, and rapidly 
spreads, assuming an inflammatory character. The 
attention of the physician must be called to this. 
Apply a warm-water dressing should his visit be 
delayed. 

SECONDARY BLEEDING FROM THE NAVEL. 

At the time of, or several days after, the sepa- 
ration of the cord, bleeding may take place from 
the navel. In this event, which is fortunately un- 
common, place the point of the finger over the part 
and steadily, but gently, press it until medical aid 
can be obtained. 

When a bleeding growth appears at the navel, 
wind a piece of very narrow tape closely around it 
and leave the whole undisturbed. Under these cir- 
cumstances the hemorrhage quickly stops and the 



252 HYGIENE OF THE NURSERY. 

growth soon sprouts over the upper edge of the 
tape and, strangulating itself, drops off. 

YELLOW STAINING OF THE SKIN. 

During the first few days of life, especially after 
a difficult and tedious birth, there is apt to be intense 
congestion of the skin, followed, as the redness fades, 
by a brownish yellow discoloration. This usually 
disappears by the tenth day. The coloration resem- 
bles that of true jaundice, but there is no yellow 
staining of the whites of the eyes, nor change in 
the color of the urine or faeces. Real jaundice 
occasionally occurs and fs a serious condition, re- 
quiring careful management. 

RETENTION OF URINE AND FAECES. 

Infants frequently do not pass urine for many 
hours after birth. Sometimes not for days. This 
may be due to complete want of secretion or to 
some temporary engorgement of the kidneys, which 
can be relieved by drawing the blood to the surface 
by immersion in a warm bath; a procedure to be 
adopted in all cases in which no urine is voided 
during the first twenty-four hours of life. Often, 
in lieu of the bath, it will suffice to lay a piece of 
flannel, wrung out of hot water, upon the lower 
third of the abdomen — the region over the bladder. 

Occasionally some physical malformation leads 
to retention of urine, and it is the duty of the nurse 



EMERGENCIES. 253 

to be on the lookout, so that she may early call the 
physician's attention to the matter. The same con- 
dition may also prevail in the bowel, and when 
twelve hours elapse without any evacuation the 
parts ought to be carefully examined. 

SWELLING OF THE BREASTS. 

At birth, or within the following day or two, the 
mammary glands of an infant may swell, become 
hard and painful, and secrete a thin fluid much 
resembling milk. Never make any pressure to re- 
move the secretion, as it may lead to inflammation. 
When the swelling is moderate, judicious inaction 
is best, but in severer cases, when the surface is red, 
and the parts much swollen, and hard and tender 
to the touch, a hot-water dressing must be con- 
stantly applied. 

INFLAMMATION OF THE EYES. 

This is a most important condition, and, from the 
outset, requires the attention of the physician and 
the greatest care on the part of the nurse. 

The inflammation usually comes on about three 
days after birth, in the following manner : on wak- 
ing from sleep, the child's eyes are slightly glued 
together ; their edges, particularly at the corners, 
are redder than is natural, and on turning down the 
lower lid a little white matter will be observed on 
the inside. Light causes pain and there is a 



254 HYGIENE OF THE NURSERY. 

tendency to keep the eyelids closed. After a short 
time the lids swell, become red on their external 
surfaces, and a large quantity of matter is secreted 
and constantly pours from the eye. Apart from 
pure medicinal treatment, the nurse must keep the 
eye free from discharge by constantly washing away 
the matter secreted. Burn the rags or cotton used 
in this process at once, and it is most important for 
the attendant not to carry any of the discharge to 
her own eyes. 

HARE-LIP AND CLEFT-PALATE. 

These are deformities requiring the attention of 
the surgeon, and under ordinary circumstances his 
aid should, in case of simple hare-lip, be sought 
within the first six months of the child's life, so that 
the operation may be well over before dentition 
begins. The fourth month is the period of elec- 
tion, but should there be difficulty in sucking and 
any evidences of inanition, the operation may be 
performed at an earlier age. The operation for 
cleft-palate should not be undertaken before the 
end of the second year. 

So far as the mother is concerned, the question 
of importance is whether or not there is any inter- 
ference with the act of sucking. If hare-lip be 
trifling, the infant will be able to suck, provided the 
mother's nipple be large and the milk flow r s freely; 



EMERGENCIES. 255 

when the reverse is the case, resort to a nipple 
shield. In grave cases, especially when hare-lip is 
associated with cleft-palate, the child is unable to 
suck either from the breast or from the bottle, and 
must be fed from a spoon. Occasionally one can 
succeed in feeding a child so affected from a bottle, 
by resorting to a false palate. This consists of a 
bit of thin india-rubber, cut the size and shape of 

Fig. 23. 




TIP WITH FALSE PALATE. 



the roof of the mouth and fastened by several firm 
stitches to an ordinary bottle tip (see Fig. 23). In 
using this instrument, the nurse must insert it into 
the mouth in such a way that the rubber diaphragm 
will come uppermost and bridge over the imperfect 
portion of the palate. 

TONGUE-TIE. 

In this condition the bridle beneath the tongue 
is either too short, or is attached so near the tip of 



256 HYGIENE OF THE NURSERY. 

the tongue as to interfere, at first, with the move- 
ments of the organ in sucking, and, afterward, in 
speaking. Although frequently suspected, it, in 
reality, occurs very rarely. The best way to deter- 
mine if tongue-tie exist or not, is to watch whether 
the infant can protrude the tip of the tongue beyond 
the lips. If so, it will be able to suck a good nipple 
readily, and nothing need, nor ought, to be done. 
Should the reverse condition prevail, it will be 
necessary to nick the bridle, and, as there is con- 
siderable danger of hemorrhage in this operation, a 
surgeon must always be consulted. 



ACCIDENTS AND DISORDERS OCCURRING IN 
INFANCY AND CHILDHOOD. 

BRUISES. 

A contusion or bruise must be treated as soon 
as received, if one would relieve pain, lessen swell- 
ing and prevent the formation of a black and blue 
spot. Compresses wet with hot water, a light ice 
bag,* or a lotion of fluid extract of witch-hazel, are 
the best remedies. A bruise upon the head in the 
case of a young infant, and especially when followed 



* Heat and cold act in the same way upon the blood vessels, con- 
tracting them and preventing the transudation of blood. It is the 
changes occurring in the blood after leaving the vessels that produce 
the discoloration. 



EMERGENCIES. 257 

by paleness and vomiting, is not to be carelessly- 
overlooked, since it is sometimes the origin of con- 
vulsions. 

SPRAINS. 

Do not make light of a severe sprain, for the 
consequences are often more lasting than those of a 
broken bone. 

Much care and patience will be required in the 
management of sprains, the great point being to 
secure rest for the injured part. Should the knee 
or ankle joint be involved, put the patient to bed 
and swathe the part in a hot-water dressing, or in 
compresses soaked with arnica or fluid extract of 
witch-hazel. When a joint of the upper extremity 
is involved, it is, of course, unnecessary to confine 
the child to bed ; but at the same time the limb 
must be placed in such a position as to be as quiet 
as possible, while the local applications already 
mentioned should be employed. Later, passive 
motion must be practiced in order to prevent per- 
manent stiffness. A sprain, however, needs the 
surgeon's attention as much as a broken bone. 

FRACTURES. 

The breaking of a bone is indicated by deformity 
of the limb, such as bending, shortening or twist- 
ing, and when this occurs, much suffering to the 
patient and injury to the part may be saved by a 
17 



25$ HYGIENE OF THE NURSERY. 

little careful management. In lifting the child from 
the spot where the accident happens and carrying 
him to a bed, it should be one person's duty to sup- 
port tenderly the injured limb, instead of allowing 
it to dangle loosely. Once in bed, lay it upon a 
soft, rather broad pillow ; double this around the 
limb, and tie up tightly so as to afford protection 
from jars or shaking. 

Beyond this, nothing should be undertaken until 
the physician arrives, except — in case of fracture of 
the lower extremity — the preparation of the bed. 
This consists in arranging a firm, though not too 
hard, mattress, with two or three under blankets 
for the sake of warmth. 

CUTS. 

These may be clean % as when made by a knife; 
torn, by a broken plate ; or abraded, by a fall on 
hard, rough ground. If large and deep, the sur- 
geon should be called at once. In trifling cases, 
the nurse must first thoroughly cleanse the wound 
by sponging it with hot water, and check the flow 
of blood by pressure, by the application of hot 
water, or — should the hemorrhage be obstinate — 
by the use of a solution of alum. In the case of a 
knife cut, the next step is to press the edges to- 
gether and fix them in this position by applying a 
number of narrow strips of surgeon's adhesive 



EMERGENCIES. 259 

plaster at short intervals across the wound. Atom 
wound may be dressed in the same way, but greater 
care is required to coadapt the edges. For abra- 
sions, the best application is a piece of lint covered 
with vaseline or other bland ointment. The plaster 
dressings need not be renewed until the strips be- 
come loose, but the lint and vaseline may be 
changed twice a day. When an artery is cut, the 
flow of blood must be checked by pressure on the 
vessel above the seat of injury; in the case of a 
vein, below it. Arterial blood flows in jets and is 
scarlet ; venous blood runs in a continuous stream 
and is purple in color. 

BURNS AND SCALDS. 

The danger from burns or scalds is in direct pro- 
portion to the extent of surface involved and the 
depth of tissue destroyed. Fortunately, the major- 
ity of cases are trifling, and usually the hands or 
face are the parts that suffer. In these instances 
there are two things to be done ; first, to relieve 
pain, and second, to encourage healing. To accom- 
plish the former, apply a saturated solution of 
baking soda ; for the latter use some mild ointment 
— fresh lard, for example — and keep the injured 
part protected from the air by a dressing of cotton 
batting. 

Should the child's clothing take fire, remember 



26o HYGIENE OF THE NURSERY. 

that an upright position not only favors the spread 
of the flames, but encourages their approach to the 
neck and head. Any movement of the body, too, 
aids the flames by bringing fresh currents of air in 
contact with the burning materials. Therefore, do 
not let the child run about, but seize him, throw 
him down upon the floor and envelop his body 
closely in the hearth rug or a woolen table cloth. 

Should the child have fallen into a tub of scald- 
ing water, remove him immediately and undress 
him. In taking off the clothing, be careful to do 
it so gently as not to break the blisters produced 
by the moist heat, and should the underclothing 
stick anywhere to the surface, the garments must 
be cut away piecemeal, leaving the adherent por- 
tions untouched. 

After the above preliminaries put him, in either 
case, at once to bed. Next, prepare a number of 
pieces of old muslin corresponding in size with the 
injured areas, spread these with fresh lard or cosmo- 
line, apply them and cover all with a thick layer of 
cotton batting. Should the patient complain of cold 
hands or feet, or of faintness, a little whiskey or 
brandy may be administered and artificial heat 
applied to the extremities if these be uninjured. 
Nothing else should be done without the physician. 



EMERGENCIES. 26 1 

STINGS OF INSECTS. 

Children, being more ignorant, are more fre- 
quently stung by bees, wasps, and other insects, 
than adults. Examine the wound the first thing 
with a magnifying glass, and if the sting be still in 
the tissues, extract it with a pair of tweezers, or 
squeeze it out by firm pressure in the neighborhood 
of the puncture. After this, apply aromatic spirits 
of ammonia or eau de Cologne. These will relieve 
the pain and itching. When the sting produces 
great pain and inflammation, apply a flaxseed poul- 
tice for twenty-four hours. The frequent use, 
afterward, of camphorated soap liniment will be 
productive of good results. 

FOREIGN BODIES IN THE EAR. 

When a foreign substance has entered the ear, the 
plan for its extraction depends somewhat on the 
nature of the material. In any case, however, bend 
the child's head toward the affected side, cause him 
to open his mouth as wide as possible, and at the 
same time gently pull the external ear upward and 
backward. In this way the external canal of the 
ear is straightened and stretched to its widest ex- 
tent, and a small body like a bead may drop out. 
Another method is to wash the foreign body away 
with warm water and a syringe. Should the sub- 
stance be of a nature to increase in size by absorb- 



2 2 



HYGIENE OF THE NURSERY. 



ing moisture, such as a pea or bean, its extraction 
must be left for the physician, though it is to be 
delaved no longer than absolutely necessarv. When 
an insect enters the ear, the externa! canal must at 
once be filled with fresh olive oil. 

: DIES IN THE EYE. 

A - : plan for removing cinders and the like 

from the eye is to pull the upper eyelid forward and 
downward, by gi g the eyelashes, and direct the 

child to look upward. In this way the lashes of 
the lower lid are made to sweep over the inside of 

Fig. :- 




METHOD OP EVERTING UPPER EYELID. 



the upper one, and thus may brush away the foreign 
body. If this be unsuccessful, and if the offending 
substance be in sight, remove it with the corner of 
a fine handkerchief. If not seen on the eyeball, it 
must be looked for beneath the lids. It is e 
enough to pull down the lower lid and examine its 



EMERGENCIES. 263 

internal surface ; in the case of the upper lid, how- 
ever, it is necessary to perform eversion ; this is 
done by drawing the lid downward and forward, and 
turning it over a thin lead pencil. (Fig. 24.) Direct 
the child, in the meanwhile, to look down. When 
the intruding body is disclosed by this process, it 
may be brushed away by a little cotton twisted 
upon the end of a match stick, or better by a small 
earner s-hair brush ; the touch must be very gentle, 
and no prolonged effort made if the mote be im- 
bedded. Treat any slight irritation following this 
accident and the process of removal by frequent 
applications of hot water. 

FOREIGN BODIES IN THE NOSE. 

Children frequently insert shoe buttons, peas, 
beans, and other small objects into the nose. When 
these are not too firmly fixed, or have not been 
pushed too far up, they may be removed by closing 
the opposite nostril and causing the child to blow 
his nose forcibly. Should any difficulty be expe- 
rienced, it is better to consult a physician than use 
persistent force. 

FOREIGN BODIES IN THE THROAT. 

A large, unchewed mass of food, a fish bone, or 
some metallic substance, such as a piece of money, 
may become lodged at some point in the throat. 

When this occurs, immediately insert the finger 



264 HYGIENE OF THE NURSERY. 

and thumb into the mouth, pass them as far down 
the gullet as possible, and if any object be felt make 
an attempt to pull it forth. 

Instead of lodging in the upper part of the gul- 
let, the foreign body may be arrested midway in its 
course to the stomach. Let the child then partially 
masticate and swallow a piece of bread and several 
mouthfuls of water, which will probably assist the 
object's passage into the stomach ; if not, medical 
skill will be required. 

Foreign bodies, such as buttons and coins, that 
pass directly into the stomach give rise to little 
trouble, and soon find their way through the ali- 
mentary canal, and are voided from the rectum with 
the ordinary faecal evacuations. Laxative medicines 
are never needed unless the bowels be absolutely 
confined, and then moderate doses of castor oil are 
the most suitable. 

BLEEDING FROM THE NOSE. 

Hemorrhage from the nose is sometimes so ex- 
cessive as to lead to debility, or even threaten serious 
results. An injury or abrasion of the lining mucous 
membrane is the usual cause of hemorrhage, though 
it may result from certain constitutional conditions. 
To arrest the bleeding, put the child upon a bed, 
with the head and shoulders well elevated. First 
make pressure, with the thumb and index finger, on 



EMERGENCIES. 265 

the root of the nose, i. e., that portion between the 
eyes, or on either side of the nostrils where the 
blood vessels ascending from the lip are felt to 
pulsate. Should this fail, after a reasonable time, 
plug the nostril from which the blood flows with a 
cone-shaped pledget of absorbent cotton or lint; 
this may either be dry or saturated with a solution 
of alum and water as hot as can be borne. The 
inhalation of the vapor of spirits of turpentine, or 
the immersion of the feet and legs in a hot mus- 
tard foot bath, are each successful in some cases. 
If the bleeding be obstinate, apply a piece of ice 
wrapped in flannel to the forehead or the back of 
the neck. 

EAR-ACHE. 

Ear-ache is a very common cause of crying in 
infancy and childhood. Screaming from ear-ache 
may be distinguished from that due to pain in the 
bowels, another fruitful source of crying, by the 
former being more continuous, and by the child 
frequently carrying his hand to his head ; again, in 
ear-ache the passages from the bowels are natural, 
while in bowel-ache they are usually altered in 
character and offensive. 

Put into the ear, for a short distance, a small 
piece of absorbent cotton saturated with a little 
warmed olive oil containing a few drops of lauda- 
num, or, better still, with a two per cent, solution 



266 HYGIENE OF THE NURSERY. 

of cocaine. At the same time dry or moist heat 
may be applied to the external ear. 

COLD AND COUGHS. 

A cold in the head is indicated by watery eyes, 
sneezing — with a discharge of mucus from the nose 
— and a nasal voice. Simple remedies are often 
efficacious. Frequently grease the forehead and 
bridge of the nose with mutton suet; insert a little 
vaseline in the nasal orifices, and, should the skin 
be hot, administer a mustard foot-bath. 

An ordinary cold — or, in medical language, a 
bronchial catarrh — is usually preceded by a cold 
in the head, and is indicated by a hoarse cough, in- 
creased rapidity of breathing, and fever. 

The methods recommended for colds in the head 
are also useful here. In addition, rub the chest 
thoroughly, three times a day, with a liniment of 
turpentine and sweet oil — one part to three; keep 
the child in one room at a temperature of J2° F. ; 
allow a light diet, and summon medical aid. 

VOMITING. 

The most healthy infant, even though it be fed 
at a normal breast, often expels a portion of each 
feeding. This is an act of regurgitation rather than 
vomiting, and is, in reality, a natural method of re- 
lieving an over-burdened stomach. 

Vomiting proper is preceded by the sensation of 



EMERGENCIES. 267 

nausea; is followed by lassitude, and is often at- 
tended by fever. It indicates some disorder of the 
stomach. For its relief, perfect rest for the whole 
body ; several hours' starvation, or rest for the 
stomach, and a reduction in the quantity and 
strength of the food, are necessary. Bits of ice, 
soda-mint, lime water, and a mixture of equal quan- 
tities of cinnamon water and lime water, in teaspoon- 
ful doses, are simple and efficient remedies ; a weak 
mustard plaster placed upon the pit of the stomach 
is always useful. Should the symptom be obsti- 
nate, however, the case becomes too serious for the 
mother to manage on her own responsibility. 

COLIC. 

Colic is a very common affection of infancy. It 
usually occurs in the period between birth and the 
end of the third month, and gives rise to much dis- 
comfort, both to the infant and its attendants, by 
causing fretfulness, crying and wakefulness. The 
treatment is very much one of diet and properly 
prescribed drugs. Still, there are some domestic 
remedies which may be used safely and with suc- 
cess. Thus, the body should be anointed twice a 
day with warm olive oil and enveloped in a broad 
flannel binder. It is even more important to keep 
the feet warm, and for this purpose thick socks or 
long woolen stockings should be worn, and, in bad 



268 HYGIENE OF THE NURSERY. 

cases, artificial heat must be applied by hot water 
bottles. Medicines are indicated chiefly during 
attacks of pain. A serviceable prescription is ten 
drops of gin in a teaspoonful of sweetened warm 
water, or a small teaspoonful of hot soda-mint. It 
is also well to administer a teaspoonful of cara- 
way water after each nursing, or with each bottle 
of food. 

When a paroxysm of pain is violent enough to 
lead to depression of the fontanelle and threaten 
collapse, place the infant in a warm bath for five 
minutes. After removing and carefully drying 
him, wrap him in a blanket ; put a flaxseed poultice 
with a dash of mustard over the abdomen; apply a 
hot water bottle to the feet ; relieve the bowels by 
an enema of warm water, and by the mouth, give 
him ten drops of gin or brandy in warm water. If 
the fontanelle still remain depressed, continue the 
stimulant in doses and at intervals proportioned to 
the urgency of the symptoms. 

CONSTIPATION. 

Habitual constipation is such a common occur- 
rence in infancy and childhood that it warrants a 
somewhat detailed consideration. The methods 
that may safely be employed to clear the lower 
bowel of accumulated faeces, or, in other words, to 
relieve the actual state of constipation, will be first 



EMERGENCIES. 269 

noticed, for this is always a necessary step when 
there is painful straining, and in case there has been 
no movement for a day or more. For this purpose 
injections are most efficient, and when given with 
care, are entirely free from danger. 

A serviceable plan is to inject into the rectum, 
according to the age of the patient, from one to four 
teaspoonfuls of warm olive oil ; allow it to remain 
for six hours, and then use one or more injections 
of castile soap and warm water ; olive oil, soap and 
warm water, or table salt and warm water. The 
preliminary injection of oil softens the faeces, while 
the subsequent ones have the additional effect of 
distending the walls of the rectum, thus bringing 
about muscular contraction and expulsion of its 
contents. Should a compact faecal mass be present 
at the anus and be too bulky to escape — a condition 
often visible during straining — more liquid must be 
injected, and if this fails the mass must be broken 
up by the finger and its passage assisted by gentle 
pressure upon the parts behind the anus while ex- 
pulsive efforts are being made. The process of 
breaking up is easy, as the anus is widely distended 
at such times. In obstinate cases little result may 
follow a single administration of the injections, 
though a course of one or two oil injections and 
purgative enemata for several successive days rarely 
fails to empty the bowel. 



27O HYGIENE OF THE NURSERY. 

The best syringe for children is one of hard 
rubber with a long, smooth, nozzle, having a 
capacity of six fluidounces. When oil is injected, 
the intention being to have it remain in the rectum 
and act mechanically on the faeces, its retention is 
best secured by firmly pressing a warmed pad of 
flannel against the anus for five minutes after the 
insertion, the patient, in the meanwhile, lying upon 
his back. The laxative enemata must vary in bulk 
with the age of the child, or, in other words, with 
the capacity of the rectum ; one fluidounce (two 
tablespoonfuls) will be sufficient for an infant of six 
weeks, while from four to six fluidounces are 
required at the age of two years. The quantity of 
oil, salt, or soap to be used must depend upon the 
quantity of water — two teaspoonfuls of oil or one 
teaspoonful of salt to eight tablespoonfuls of water 
being a good proportion, and if soap be employed, 
it is sufficient to stir a bit in the water until suds 
begin to form. After drawing the fluid — which 
must be tepid — into the syringe, grease the nozzle 
well and gently insert it into the anus, directing the 
point a little toward the patient's left; next, slowly 
force down the piston until all the liquid is expelled 
or complaints of pain indicate that the bowel is 
sufficiently distended. If it be possible to force 
retention for a moment or two by pressure on the 
anus, the movement will be freer and easier than if 



EMERGENCIES. 2*]\ 

the fluid be allowed to flow away at once. The 
best positions for the child are either on his back 
with his legs well drawn up, or resting on his 
abdomen across the nurse's lap. 

Injections of glycerine and glycerine supposi- 
tories are also very useful for the purpose of un- 
loading the lower bowel. When glycerine is em- 
ployed, the quantity to be injected varies from one 
to two teaspoonfuls, according to the age of the 
child, and the best instrument to use is the bulb 
syringe, previously recommended. See p. 235. 

For the prevention of further constipation the 
diet must be regulated according to the rules given 
in Chapter vin, and besides regulating the food and 
hours for meals, bathing, sleep, exercise and cloth- 
ing, care must be taken to establish fixed habits of 
defecation. 

In my experience the youngest infant can be 
taught to use a chamber, and if this vessel be pre- 
sented each day at the same hour he soon falls into 
regular ways. Should faulty habits be established, 
or constipation exist, resort to injections, and ab- 
dominal massage at the same hour each day. 

After the third year the best period of the day 
for the bowels to be moved is immediately after 
breakfast, and no call of duty or pleasure should 
be allowed to interfere. When constipation is to 
be overcome natural efforts must be made then. 



272 HYGIENE OF THE NURSERY. 

These efforts may at first be ineffectual, but much 
can be accomplished by perseverance in a daily, 
sustained effort, for about ten minutes. When this 
plan fails, use injections or other methods of relief, 
taking care to keep to a certain hour, that the for- 
mation of a habit may be encouraged. 

Thorough rubbing of the abdomen is often suc- 
cessful in inducing a movement of the bowels. 
Gentle pressure should be made with the palm of 
a well-warmed hand, and the movements directed 
first, from the brim of the pelvis on the right side, 
upward to the rib margin, then across from the 
right to the left, and finally downward on the left 
side from the margins of the ribs to the brim of 
the pelvis again. Such manipulation excites peri- 
staltic action, and encourages the passage of the in- 
testinal contents along the large bow T el toward the 
anus. Ten minutes is quite long enough to continue 
the rubbing. The manipulation may be rendered 
more effective by using warm sweet oil, or a weak 
ammonia or turpentine liniment as an inunction. 

With children of six years and upward, daily 
cold spongings of the body are very beneficial, 
followed by frictions with a coarse towel until the 
surface is red. 

Manna, phosphate of sodium, and soap supposi- 
tories are among the medicines that may be safely 
used in the nursery. 



EMERGENCIES. 273 

Manna, which imparts a 9weet taste, may be 
dissolved in the food, and given from the bottle as 
often as required; a piece as big as a pea, once, 
twice or three times a day, will be sufficient for an 
infant of six months. 

Phosphate of sodium — an admirable laxative — 
can also be administered with the food ; five or ten 
grains, three times daily, is the proper dose at the 
same age. 

Soap suppositories must vary in strength with 
the age. At two months one grain of soap to ten 

Fig. 25. 




SOAP STICK. 



grains of cocoa-butter is the proper proportion ; at 
one year the quantity of soap may be increased to 
five grains in each suppository, and so on. A 
substitute for soap suppositories may be prepared 
in the nursery, as follows : Cut from a bar of good 
castile soap a piece two inches long and half an 
inch thick. Scrape this into a cone, pointing one 
end like a sharpened pencil, but with a blunter 
point and more gradual slope; make it quite 
smooth by rubbing the surface with a wet rag 
(see Fig. 25). When the soap stick is used anoint 
18 



274 HYGIENE OF THE NURSERY. 

the pointed end with vaseline and gently insert it 
into the rectum and hold it there until the action 
begins. It is not desirable to leave any fragments 
of soap in the rectum. 

CONVULSIONS. 

Convulsions arise from so many diverse causes, 
that it is impossible to indicate more than what is 
to be done during the fit and prior to the arrival 
of the physician. 

When the attack comes on, the child must be 
undressed at once and plunged into a hot bath 
for five minutes; this bath must contain enough 
mustard flour to stimulate the skin thoroughly. 
This usually restores consciousness and checks the 
muscular twitching. Should there be a distinct 
history of overloading of the stomach, give an 
emetic of ipecacuanha, and after this has operated, 
a purgative dose of castor oil. One or more doses 
of bromide of potassium, five to ten grains, accord- 
ing to the age, may be also safely given ; this salt 
must always be administered in solution. 

A CHILL. 

This is always a serious occurrence and warrants 
sending for the doctor. Before his arrival, put the 
child to bed, surround him with bottles containing 
hot water, place a moderately strong mustard plas- 
ter over the abdomen or over the region of the 



EMERGENCIES. 275 

heart, and administer whiskey and hot water in 
small doses and at short intervals. 

The ailments of children do not so frequently 
begin with a chill, as do those of adults, but when 
they do, it is a more decided indication of the 
future gravity of the attack. 

FEVER. 

It is not my intention here to refer to the man- 
agement of the essential fevers, for I hold that 
neither mother nor nurse is capable of managing 
them without professional assistance. However, 
the table on page 276, exhibiting the features of 
the eruptive fevers will answer some of the ques- 
tions which so frequently suggest themselves to 
the minds of anxious mothers. 

It may be well to give a few directions as to the 
management of a fever before the arrival of the 
physician. Every fever — whether it be due to a 
poison circulating in the blood or to a passing irri- 
tation of little or no moment — is attended by the 
following symptoms, namely : heat of skin, lassitude, 
loss of appetite and thirst. When these features 
arise, the mother must be on her guard and take 
steps to place her charge in the best possible con- 
dition. Give the child, the first thing, a mustard 
foot bath ;* then put him to bed with only sufficient 

* See page 146. 



276 



HYGIENE OF THE NURSERY 



ERUPTIVE FEVERS. 



6 



E 1 \ 

■ - a 


C 


Im 



U 


1 
h 

-2 


C 
— s 

'Z Z 
11 — 


■ 
- g 

- 

~ z 

fi"S 

3 Jj 
O = 

U 


TO tD 

Measles. 14 
days. 


4th day of 
fever, or after 
72 hours' ill- 
ness. 


Small, dull, 
red pimples, 
appearing be- 
hind the ears 
and on face. 


On 7th day 
of fever. 


9 days. 


From sec- 
ond day, for 
exactly 3 
weeks. 


Scarlet 2 to 7 
Fever. da vs. 


2d day of 
fever. orafter 
24 hours' ill- 
ness. 


General rosy 
blush appears 
first about neck 
and shoulders. 


On 5th day 
after fever. 


8 or 9 

davs 

'(This 
does not 
i n cl u d e 
sequels.) 


Fourth 
day, for 6 or 
7 weeks. 


Typhoid '° t0 


7th to 14th 

day. 


Rose-colored, 
slightly elevat- 
ed spots, few 
in number, 
chiefly on ab- 
domen. 




14 to 21 
days. 


Not con- 
tagious. 


Chicken- 
pox. 


8 to 16 
days. 


2d day of 
fever, or after 
24 hours' ill- 
ness. 


Appears i n 
crops on back 
and abdomen, 
small, red pap- 
ules rapidly 
passing into 
globular vesi- 
cles. 


Thin 
scabs form 
about 4th 
day of 
fever. 


4 to 7 
days. 


First day, 
for two 
weeks. 


Small- 
pox. 


M 

days. 


3d day of 
fever,or after 
48 hours' ill- 
ness. 


Small, hard, 
red pimples, 
becoming 
cles, then pus- 
, appear- 
ing first on face 
and neck. 


Scabs 
form on 
9th cr 10th 
day of 
fever, and 
fall off 
,about the 
: 4 th. 


14 to 21 
days. 


First day, 
for about one 
month. 



EMERGENCIES. 2*J7 

covering to keep up a normal body temperature. 
Reduce the diet to the simplest possible basis, milk 
food being the safest. A moderate quantity of pure 
water, or of some effervescing saline water, and of 
ice, may be allowed. Febrifuges, as aconite, or 
even sweet spirits of nitre, had best not be given 
without advice, and quinine or other remedies are 
not to be trifled with. 

Should head-ache be severe, place cold com- 
presses upon the forehead, or a weak mustard 
plaster (one part of mustard to six of flour) on the 
nape of the neck. 

Free urination should be encouraged by hot 
compresses over the bladder, and it is well to secure 
a free action of the bowels by a mild saline laxative. 

CONTAGIOUS DISEASES AND DISINFECTION. 

There are certain points connected with the nurs- 
ing of contagious diseases and the subject of dis- 
infection that are worthy of mention. 

In every case of contagious disease, allow in the 
room only those who are necessary to nurse the 
sick. The nurse must avoid over-fatigue, have 
regular meals of digestible and nourishing food, 
and fixed hours for sleep and relaxation. The 
chamber selected for the sick room should be large, 
well ventilated, and as near the top floor of the 



2jS HYGIENE OF THE NURSERY. 

house as possible. Upholstered and stuffed furni- 
ture, curtains, hangings, carpet and other articles 
capable of holding disease germs, are difficult to 
disinfect, and should be removed before the en- 
trance of the patient ,• in fact, to put this matter in 
a nutshell, the sick room should contain only such 
furniture as will be absolutely needed by the patient 
and nurse. Scrupulous cleanliness is essential. 
Remove dirty dishes, vessels with discharges, soiled 
napkins, and the like, at once. 

Disinfectants are substances that destroy the 
infective power of infectious materials, and must 
not be confounded with either antiseptics or arres- 
tees of putrefaction, or with deodorizers or neutra- 
lizes of bad smells. 

In the use of disinfectants, it is important to bear 
in mind that contagious virus must be destroyed at 
its source. As this, of course, is the body of the 
sick, all discharges must have their power for evil 
destroyed as soon as possible. Receive discharges 
from the mouth and nose, especially in cases of 
scarlet fever and diphtheria, in bits of rags, and 
burn them immediately after use. When the skin 
is affected, as in scarlet fever, for example, the 
flakes that fall away are highly infective. To pre- 
vent these becoming disseminated, the surface 
should be anointed several times a day with vase- 



EMERGENCIES. 279 

line, lard or cocoa-butter, either of which substance 
will be rendered more efficient by the addition of 
carbolic acid (one part to forty). 

Articles used about the patient, such as sheets, 
pillow-cases, blankets and clothes, should not be 
removed from the chamber until they have been 
soaked for at least an hour in the following disin- 
fecting fluid : — 

Sulphate of zinc 8 ounces. 

Carbolic acid , I ounce. 

Water 3 gallons. 

Place, after this, the soiled articles in boiling 
water for washing. 

Articles not requiring to be frequently changed, 
such as pillows and mattresses, need fumigation. 
This may be accomplished at the termination of 
the sickness. 

Keep a small quantity of the above fluid or of a 
solution of corrosive sublimate (i to 500) in all 
vessels used for receiving the discharges of the 
patient, and, after these are used, empty quickly 
and clean with boiling water. Water closets or 
privy wells into which these discharges are poured 
must also be disinfected each day with a solution 
of copperas (one pound to the gallon). 

Fumigate the sick room itself as soon as the 
patient leaves it. To do this, tightly close the room 



280 HYGIENE OF THE NURSERY. 

and stuff all apertures, such as keyholes, loose 
window sashes, spaces under doors and so on, with 
cotton or rags. Then place a quantity of roll 
sulphur,* broken into small fragments, in a saucer, 
standing either in a large iron kettle or supported 
by two bricks set in a tub partially filled with water. 
Next, sprinkle a little alcohol over the sulphur and 
apply a live coal, and as soon as combustion begins, 
leave the room, shutting the door of exit. The 
room must remain closed for at least twelve hours 
and then be thoroughly aired. 

Wood-work and walls, if painted, should be 
wiped down with a solution of chloride of lime 
(one ounce to the pint) or carbolic acid (one drachm 
to the pint), and then scrubbed with soap and hot 
water. Re-papering and fresh painting are neces- 
sary in cases of scarlet fever or smallpox. 

The person of the patient or nurse may be dis- 
infected by washing with a two per cent, solution 
of carbolic acid. 

Both milk and water will carry disease germs, 
and hence both must be thoroughly boiled when 
there is any danger of their being contaminated. 
Never give delicacies or articles of food that have 
stood in the sick room to other members of the 
household. 



* The quantity of sulphur required is three pounds for every 
thousand cubic feet of space. 



EMERGENCIES. 28 1 

VARIOUS DRESSINGS. 
POULTICES. 

Poultices may be made with Indian meal, bread, 
starch, ground slippery elm, flax-seed meal, or, in 
fact, any material that will retain heat and moisture. 
Flax-seed meal is usually selected because it is 
bland and non-irritating; because it contains con- 
siderable oil, which gives it great heat-retaining 
properties, and because it is cheap. 
. All poultices should be large, from half an inch 
to an inch thick ; applied as hot as can be borne, 
and renewed as soon as cold. A covering of oil- 
silk or thin rubber cloth is useful to prevent rapid 
cooling. 

FLAX-SEED POULTICE. 

Take a perfectly clean bowl, pour in the requisite 
quantity of boiling water, then add the flax-seed 
meal slowly, stirring continually with a large spoon 
to prevent the formation of lumps, until it becomes 
stiff enough not to run freely. Spread between 
two layers of old muslin, folding the edges over so 
as to avoid soiling the part to which it is applied. 

THE JACKET POULTICE. 

The jacket poultice, so often employed in cases 
of pneumonia, requires some skill in its preparation. 

For a child from one to three years old, use about 
a pound of flax-seed meal in each poultice. 

Take a piece of muslin or a large towel long 



282 HYGIENE OF THE NURSERY. 

enough to go all around the patient's chest, and of 
sufficient width, when folded on itself, to extend 
from the collar bone to a few inches below the 
lower end of the breast bone. After the meal is 
properly mixed, spread it evenly over one entire 
half, lengthwise, of the cloth, which should then be 
folded over. Place this around the chest, with the 
open edge upward, and fasten behind. It should 
be held up by a tape passing over each shoulder. 

Put this poultice on as hot as the nurse can' 
tolerate it against her cheek ; cover with oil-silk 
and renew every five or six hours. When the cool 
poultice is to be removed have a hot fresh one 
ready for immediate application. 

BREAD POULTICE. 

Make a bread poultice by soaking a muslin bag 
filled with bread crumbs, for a few moments in 
boiling water, then squeeze it gently between two 
towels until it does not drip. 

CHARCOAL POULTICE. 

The charcoal poultice is useful in foul and slough- 
ing sores, and is prepared by incorporating some 
powdered charcoal with a flaxseed, an Indian meal 
or a bread poultice, and then sprinkling the surface 
with more charcoal. 



EMERGENCIES. 283 

PLASTERS. 
MUSTARD PLASTER. 

These plasters are used for the purpose of making 
counter-irritation, and must be graduated in strength 
according to the tenderness of the skin and the end 
to be accomplished. Pure mustard is very irri- 
tating and will quickly blister the tender skin of a 
child. Flour is the ordinary diluent, and the 
strength of the plaster usually ranges from one 
part of mustard to three, six or even more parts of 
flour. 

In making the plaster, take one teaspoonful of 
mustard flour and add to it three teaspoonfuls of 
wheat flour ; mix them together thoroughly on a 
plate, and put on as much hot water (never vinegar) 
as may be necessary to make a soft mass. Spread 
evenly over a piece of muslin. To prevent the 
mustard from adhering to the skin, place a piece of 
gauze or thin muslin over the surface of the plaster ; 
turn down the edges as in poultices. 

Remove the plaster after the surface becomes 
quite red. 

SPICE PLASTER. 

Take equal parts of ground ginger, cloves, cin- 
namon, and allspice, and one-fourth part of cayenne 
pepper ; mix the ingredients together on a plate, 
and put the whole into a flannel bag about as large 
as the hand, and wet with hot whiskey or alcohol. 



284 HYGIENE OF THE NURSERY. 

After the bag is filled it is better to quilt it; 
otherwise, as it is usually worn some length of time, 
the ingredients are apt to fall together in a lump. 

DRY, HEATED APPLICATIONS. 

Make a bag of thick flannel, somewhat larger 
than the part to be covered. Half fill it with hot 
bran, hops, chamomile flowers, or whatever is to be 
used. Apply to the part on which it is intended to 
act. Retain it there by a bandage. When the bag 
and contents become cooled, quickly remove, sub- 
stituting a few thicknesses of hot flannel until the 
bag can again be heated by placing it on a tin plate 
in the oven, or by holding it over burning coals, 
being careful, of course, not to scorch it. 

COLD WATER DRESSING. 

Take a piece of old linen or muslin large enough 
to cover the affected part. Thoroughly wet with 
cold water. Keep constantly wet by re-dipping in 
the cold water, or by gently squeezing out a wet 
sponge on the cloth, so as to keep it wet without 
dripping. The latter plan is the better, as it causes 
no disturbance of the parts beneath — an important 
consideration in many cases. 

HOT WATER DRESSING. 

The hot water dressing is prepared in the same 
way as the above, substituting hot for cold water, 
and covering with oil-silk. 



EMERGENCIES. 285 

FLANNEL DIPPED IN SPIRITS. 

Take a piece of old, soft flannel. Heat it before 
the fire. Then fold it into the size and shape 
required. Dip into hot water and wring it dry. 
While this is being done by one person, some one 
else should put some common whiskey into a shal- 
low dish over the fire, and heat it, being careful 
that the whiskey does not take fire. As soon as 
thoroughly heated, dip the flannel into it and 
squeeze out any excess of spirits, which would 
merely drip away, to the annoyance of the patient. 
Have the surface exposed, and rapidly apply the 
flannel as hot as can be borne. Over this place 
another piece of dry flannel which has been heated 
quite hot and folded like the first one. If desirable, 
a bandage may be brought around to secure them 
in position. As soon as the inner flannel, which 
was dipped in the whiskey, has become somewhat 
dry, another cne should be prepared at once and 
applied in its stead. 

TURPENTINE STUPE. 

A turpentine stupe is made by wringing a piece 
of old flannel out of hot water and sprinkling a few 
drops of warm spirits of turpentine on it. It 
should be covered with oil-silk while applied, and 
removed when sufficient irritation of the surface is 
produced. 



286 HYGIENE OF THE NURSERY. 

ADMINISTRATION OF MEDICINE. 

The administration of medicine often requires 
considerable skill, and is a task in which more 
clumsiness than tact is often exhibited. Teach the 
nurse that a child cannot swallow so long as the 
spoon is between the teeth, but that it is advisable 
to depress the tongue a brief moment and withdraw 
the spoon as soon as emptied. 

Should the child rebel, there are many ways by 
which he can be diverted, so that he shall swallow 
his medicine before he knows it. Also, should he 
have a fondness for any especial thing, such as 
sugar, jelly, etc., the taste of the medicine may be 
quite hidden by mixing it with the thing he loves. 



INDEX 



A. 

Abdomen, depression of, 23. 

distention of, 23. 
Abdominal belt, dispensing with, 103. 
Abnormal depression of temperature, 

53- 
Accidents at birth, 249. 

in childhood, 256. 
Air, importance of fresh, 109. 
Ale, 161. 
Ammonia, 79. 
Amusements, 107-116. 
Anaemia, 53. 
Analysis of cows' milk, 172. 

of human milk, 170. 

of peptonized milk, 192. 
Ankle, pressure about the, 101. 
Aphthae, 56. 
Appetite, 36. 

loss of, 37. 
Applications, dry heated, 284. 
Apron, the bath, 127-131. 
Arrowroot food, 213. 

pudding, 227. 
Artificial feeding, 167. 
Asses' milk, 171. 
Atmospheric air, the amount required 

for each child, 65. 
Author's sterilizer, 193. 



B. 

Baby band, 90. 

jumper, dangers of, 113. 
powder, 134. 
Baby's basket, the filling of, 87. 

carriage, no. 
Barley jelly, 233. 

and milk, 198. 
water, 232. 
Bath apron, 131. 

best hour for, 132. 
blanket, 145. 
bran, 146. 
cold, 129, 143. 



Bath, cooled, 143. 

hot, 145. 

mode of giving, 132. 

mustard, 146 

salt water, 146. 

sea, 140. 

soda, 146. 

table, 127. 

temperature of, 129. 

the initial, 126. 

thermometer, 130. 
Bathing, 125. 

suit, 141. 

utensils, 127. 
Bed coverings, 123. 

separate, 122. 

wetting the, 42. 
Beef essence, 223. 

juice (raw), 197, 224. 

raw, 224. 

tea, 221-222. 

and brandy enema, 235. 
peptonized, 219. 
Beer, 212. 

Bicycles, dangers of, 118. 
Binder, the, 90. 

Birth, injuries received during, 249. 
Blanc mange, 227. 
Bleeding from the navel string, 250. 

from the nose, 252. 
Body clothing, 91. 

temperature, 49. 
Boots, rubber, 105. 
Bottle tip, 204. 
Braces, 115. 

Brain, " water on the," 22. 
Bran bath, 146. 
Bread poultice, 282. 
Breast milk, quality of, 170. 

specific gravity of, 169. 
Breasts, swelling of, 250. 
Breathing, accelerated, 44. 

diminished frequency of, 45. 
Broth, chicken, 225. 

mutton, 226. 

veal, 226. 



287 



2SS 



INDEX. 



Brows, contraction of, 19. 

Bruises, 256. 

Burns and scalds, 259. 



C. 

Cans for milk, 207. 

Cap, 103. 

Capacity of stomach, 178. 

Caraway water, 231. 

Carriage, proper kind of, no. 

Castile soap, unscented, 130. 

Cereals, 176. 

Charcoal poultice, 282. 

Chavasse s milk food, 214. 

Cheese poison, 208. 

Cheyne-Stokes' respiration, 45. 

Chicken broth, 225. 

Child, position of, while being fed, 205. 

Childhood, 18, 210. 

Chill, a, 274. 

Chorea, 245. 

Cinchona, ferrated elixir of, 161. 

Clear brown soup, 224. 

Cleft palate, 254 

Clinical thermometer, 45, 49. 

Clothing, 85. 

change of, 106. 

shortening of, 93. 

warmth of, 80. 
Coated tongue, 56. 
Cold bath, 143. 

cream, 135. 

pack, 144. 
Colds, 266. 

Cold-water dressing, 284. 
Colic, 134, 243, 267. 
Colostrum, 151. 
Compresses, 146 
Condensed milk, 174, 186, 214. 
Consomme, 225. 
Constipation, 242, 268. 
Contagion from milk, 208. 
Contagious disease, 277. 
Contraction of brows, 19. 
Convulsions, 19, 32, 274. 
Cooled bath, 143. 
Corsets, 115. 
Cough, 34. 
Cows, care of, 26. 
Cows' milk, analysis of, 171. 
Creeping, 112. 
Crib, 172. 

Cry of hunger, colic, etc., 33, 154. 
Crying, 33. 

variations in disease, 33. 
Cuts, 258. 



D. 

Deformed head, 21. 
Dentition, 56. 

abnormal, 58. 

delayed and difficult, 58. 

second, as a cause of ill health, 61. 
Development, 23. 

examples of variations in disease, 

3°- 
Diagram showing relative stature, 27. 

showing eruption of milk teeth, 

57- 
showing relation between perma- 
nent and temporary teeth, 61. 
Diarrhoea, 40. 

Diet during the first four weeks, 177. 
the first week, 182. 
tenth and eleventh months,i85. 
from the second to the sixth 
week, 182. 
the sixth week to the end of 

two months, 182. 
the third to the sixth month, 

183. 
the seventh to the ninth 

month, 184. 
the twelfth to the eighteenth 

month, 198. 
eighteen months to two and a 

half years, 199. 
three and a half years up, 270. 
up to three and a half years, 199. 
Dietary, 213. 
Diseases, contagious, 277. 
Disinfection, etc., 277. 
Donkey, a, 114. 
Drawers, separable, 94. 
Dress, or slip, 91. 

night, 101. 
Dressing gown, 102. 
Drinking, 35, 200. 
Drowsiness, long-continued, 32. 



E. 
Ear-ache, 32, 265. 
Ear, foreign bodies in, 261. 
Early rising, 121. 
Ear tabs, 105. 
Ears, water in, 133. 
Effervescing milk punch, 218. 
Effleurage, 237. 
Egg and brandy, 230. 
Emergencies, 248. 
Enemata nutritious, 234. 
Eructation of milk, 37. 
Eruptive fevers, table of, 276. 



INDEX. 



289 



Essence of beef, 223. 
Evacuations, fecal, 39. 
Excoriations, 90. 
Exercise, the infant's first, 108. 

out-door, 109. 
Extract of malt, 161. 
Eyeballs, oscillation of, 19. 
Eyes, change of color of the, 30. 

foreign bodies in the, 262. 

inflammation of the, 253. 

lividity of the lids, 21. 
Eyelids, incomplete closure of, 18. 

twitching of, 19. 



F. 

Face, the, 18. 

congested or blackened, 238. 

examples of variations in disease, 
18. 
Fsecal evacuations, general characters 

.. of '39- . 
Faeces, retention of, 252. 
False palate, 255. 
Farinaceous food, 176. 
Features of health, 17. 
Feeding, artificial, 167. 

by a wet-nurse, 164. 

from the maternal breast, 150. 

general rules for, 179. 

with cup or spoon, 158. 
Fender, 73. 
Fever, 47, 56, 275. 
Fevers, table of eruptive, 276. 
Feet, cold, 95. 

shape of, 97. 
Filtered water, 212. 
Finger nails, care of, 148. 
Fireplace, open, 72. 
Fissure of nipples, 161. 
Flannel dipped in spirits, 285. 
Flaxseed tea, 231. 

poultice, 281. 
Flour ball, 232. 
Fontanelle, conditions of, 21, 22, 23. 

when it should close, 30. 
Food, 150. 

arrowroot, 213. 

Chavasse's milk, 214. 

farinaceous, 176. 

fried, 211. 

milk, 213. 

milk sugar, 215. 

milk and white of egg, 215. 

quantity per diem, 177. 
Foods, peptonized, 216. 
Foot-bath, mustard, 146. 
Foreign bodies in the ear, 261. 

l 9 



Foreign bodies in the eye, 262. 

in the nose, 263. 

in the throat, 263. 
Fractures, 257. 
Friction, 237, 240. 
Fumigation, 279. 



Garments, method of fastening, 72. 
Garter, 95. 
Gastric juice, 173. 
Gelatine, 232. 

and milk, 228. 
Goats' milk, 171. 
Gown, dressing, 102. 
Graduated nursing bottle, 203. 
Growth, 23, 27, 28. 
Gruel, oatmeal, 229. 



H. 

Habitual constipation, 256, 268. 
Hair, change of color in, 30. 

falling out of, 149. 

tonic, 149. 
Hand, carrying of, to head or mouth, 

32. 
Hard palate, 55. 
Hare-lip and cleft palate, 254. 
Hat, light straw, 103. 
Head, shape of, 21. 

after prolonged labor, 249. 

squareness of, 22. 

when it can be held erect, 29. 
Health, the features of, 17. 
Healthy skin, characters of, 20. 
Hereditary tendency, 249. 
Hoarseness, 34. 
Hominy grits, 228. 
Horlick's Food, 181. 
Hot bath, 145. 
Hot-water dressing, 284. 
Human milk, analysis of, 170. 

substitutes for, 196. 
Humanized milk, 220. 
Hunger, 36. 
Hydrocephalus, 22. 
Hygiene of the Nursery, 17. 



I. 

Ice water, 118. 

Infancy, definition of, 17. 

Infant, development of the, 25. 

drying of the, 133. 

fed upon condensed milk, 175. 



?qo 



INDEX. 



Infant foods, 176. 

initial bath of, 126. 

overfed, 178. 

position of, while feeding, 205. 

rocking of, 124. 

the hardening of an, no. 

the jolting of an, 109. 

when able to sit up, ic8. 
creep, etc., 10S. 
Inflammation of the eyes, 253. 
Injuries received during birth, 249. 
Insects, stings of, 249. 



J- 



Jacket poultice, 281. 
Jaundice, 19, 21, 43. 
Jeily, sago, 230. 
Junket, 228. 

with egg, 228. 



L. 

Lactation, 152. 

Lactometer, 172. 

Leggings, 103, 105. 

Legs, bare, 85. 

Light, night, 67. 

Lime, saccharated solution of, 181 

water, 180, 233. 
Lips, lividity of, 21. 



M. 

Malt extract, 161. 

Mammary glands, inflammation of, 

253- 
Manna, 273. 
Manners, 115. 
Massage, 236. 

& frictions, 237. 

dry, 238. 
Mattress, 122. 
Meals, preparation of, 205. 

regularity of, 153. 
Meat broths, 221. 

enema with pepsin, 235. 
Medicine, administration of, 286. 

closet, contents of, 71, 72. 
Meigs' Food, 215. 
Mellin's Food, 181. 
Menstruation, recurrence of, 163. 
Milk and barley jelly, 198. 

and cinnamon, 234. 

and gelatine, 228. 

and oatmeal, 215. 



Milk and white of egg food, 215. 
asses', 171, 187. 
boiled, 186, 
breast, 169. 

examination of, 17T. 

regulation of the flow of, 152. 

scanty secretion of, 160. 

specific gravity of, 169. 

substitutes for, 171. 

to ascertain the quantity 
sucked, 166. 
cows', 171. 
condensed, 174. 
food, 213. 
goats', 171, 187. 
humanized, 191, 220. 
keeping of, 2- 7. 
mixed, 206. 
peptonized, 188, 216. 

analysis of, 192. 
poisoning, 208. 
powder, peptogenic, 192. 
predigested, 188. 
punch, 218. 

effervescing, 218. 
sound, 206. 
sterilized, 192. 
sugar, 215. 
teeth, 56. 

transportation of, 207. 
Mind, cultivation of, 116. 
Morals, general, 116. 
Mouth, examination of, 54. 
inflammation of, 56. 
mucous membrane of, 55. 
Mustard bath, 146. 

plaster, 283. 
Mutton broth, 226. 



N. 

Nap, the morning, 120. 

Napkins, 89. 

Navel string, 250. 

Neurasthenia, 246. 

Newly-born infant, length, weight, 

etc., 24. 
Night dress, 101, 105. 

light, 67. 
Nipple, fissures of, 161. 

protector, 162. 
Nose, 19. 

bleeding from the, 264. 

foreign bodies in the, 263. 

rubbing of the, 32. 

Nostrils, sharpness of, 19. 
Nursery, 62. 



INDEX. 



29I 



Nursery, cleaning the, 78. 

floor of the, 68. 

furnishing of the, 70. 

heating of the, 72. 

height of ceiling of the, 66. 

hygiene of the, 17. 

lighting of the, 66. 

night, 62. 

situation of the, 63. 

size of the, 65. 

temperature of the, 72. 

ventilation of the, 73, 77. 

walls and ceiling, 69. 
Nurse-maid, 80. 

cleanliness of, 84. 

face of, 82. 

selections of, age, etc , 81. 
Nursing bottle, graduated, 203. 
tip, 204. 

bottle tip, for cleft palate, 255. 
Nutritious enemata, 234. 



O. 

Oatmeal gruel, 229. 

water, 233. 
Oral mucous membrane, 54. 

respiration, 45. 
Overcoat, 105. 
Oyster soup, 226. 
Oysters, peptonized, 219. 
Oxide of zinc ointment, 135. 



Palate, false, 255. 

hard and soft, 55. 
Pancreatin, 188, 191. 
Paralysis, infantile, 244; facial, 246. 
Pasteurization, 194. 
Passages, character of, 40. 
Pearl barley jelly, 233. 
Peptogenic milk powder, 192. 
Peptonized beef tea, 219. 

food, 216. 

milk, 216. 

milk gruel, 218. 

milk punch, 218. 

oysters, 219. 
Petrissage, 237. 
Phosphate of sodium, 261. 
Physiological action of massage, 238. 
Pictures in nursery, 69, 
Pillow, the, 123. 
Plasters, mustard, 283. 



Plasters, spice, 283. 
Piatt's chlorides, 79. 
Play, 118. 

Pleuritic effusions, 247. 
Position and gestures, 31. 
Pony, the, 114. 
Poultices, 281. 

jacket, 281. 
Powder, baby, 134. 
Predigested milk, 188. 
Pregnancy, occurrence of, 163. 
Prepared chalk, 147. 
Protector, nipple, 162. _ 
Puberty, 137. 
Pudding, arrowroot, 227. 

rice, 229. 

tapioca, 230. 
Pulse, the, 46. 
Pyramid night light, 67. 



Raw beef, 222. 

juice, 197, 224. 
Reaction of cow's milk, 171. 

of human milk, 169. 
Regurgitation of milk, 37. 
Rennet, 173. 
Respiration, 43. 

Retention of faeces and of urine, 252. 
Retiring, 121. 
Rice milk, 229. 

pudding, 229. 

water, 233. 
Rickets, 22, 32, 164. 
Riding, 114. 
Rising early, 121. 
Rocking baby to sleep, 124. 
Roller skates, 118. 
Root of the mouth, 55. 
Rubber cloth, 93, 102. 
Rules for feeding, 179. 



Sago jelly, 230. 

Saliva, secretion of, 30. 

Salt-water bath, 146. 

Scalds, 259. 

Scalp, swelling of, 250. 

Sea-water baths, 140. 

Second summer, dread of, 61. 

Secondary bleeding from the navel, 

251. 
Shirt, night, 105. 
Shoes, 96. 



29- 



INDEX 



. bedroom, 102. 

knitted, worsted, 89. 
Short stockings, dangers of, S6. 
Sick room, disinfection of, - 
Skates, roller, dangers of. 
Skin, general appearance of, 19. 

of healthy child, 19. 

yellow staining of, 252. 
Sleep, 119. 

variations in disease, 32. 
Soap, Castile, 130. 

suppositories. . 
Soda bath, 146. 
Solution of lime, sacchara:, 
Sore nipples, 162. 

prevention of, 162. 
Sound milk, 206. 
Soup, clear brown, 224. 

oyster, 226. 
Spine, curvature of, 108. 
Spinal irritability, 246. 
Spo- . 

Sprains, : 5 - 
Squinting. 

h gruel, 197. 
Sterilizer, 193. 
Stick for cleaning tee:h. 147. 
Stimulants, 161. 

s . 261. 
Stockings, 95. 
Stomach, capacity of. 
Strippings, 187. 
Study, too much, 110. 
St. Vitus's dar 

Substitutes for human milk, 171. 
Suck, manner of giving, 15: 
Sugar of milk, 180. 
Swallowing 

Swelling of the breasts, 25;-. 
Swimming, 141. 
Syphilis. 82. 
Syringe for constipation, 270. 

nutritive enemata. 



Table, the bath, 127. 

of the eruptive fevers. 

showing increase in length, 24. 

showing increase in weight, 25. 
Tapioca. 230. 
Tapotement, 238. 
Tea, 212. 
Tears, secretion of, 30. 

suppression of 
Teeth, care of, 147. 

children born with, 



Teeth, milk, 56. 

permanent, order of eruption, 60. 

premature appearance c ! ". 

stick for cleaning. 147. 
Teething, increase of saliva in, 57. 

pau- 
Temperature of bath. 142. 

manner of taking, 48. 

normal, 52. 
Thermometer, bath, : 

clinical, 49. 
Throat, examination r 

foreign bodies in the, 263. 
Toes, normal position of, 97: 
Toe nails, care of, 104. 
Tongue, the. 55. 

coated, 56. 

Tonsils, 3 

Tooth brush. 148. 

Towels, bath, 131. 

Toys, 70. 

Treatment of fissure cf the nipple, 161. 

Turkish towels, 138. 

Turpentine stupe 

::r.g of eye lids, 19. 
Tyrotoxicon, 208. 



U. 

U":eration of the navel, z - : . 
Underclothing, woolen, 103. 
Urination, painful, 43- 
;. the, 41. 

amount voided in 24 he:. 

high colored, 42. 

incontinence ex. 42. 

retention of, 252. 

smoky. - 

suppression of, 
. the, 56. 



V. 

Variations in disease, 21. 
Veal broth, 226. 
Ventilatic . 
Ventilator board, 77. 

wheel, 76. 

win 
Vernix caseosa, 
Voice. 

variations in disea- 
Vomiting, 55 266. 



INDEX. 



293 



W. 

Walking, delay in, 31. 
Walks, 114. 

Waste pipe, disinfection of, 78. 
Water, filtered, 200. 

in the ears, 133. 

on the brain, 22. 
Weaning, 156. 

manner of, 157. 

premature, 159. 

sudden, 159. 
Weather, cold, 105. 

damp and rainy, 105. 
Weight, table showing increase of, 
25. 



Weight, yearly gain of, 25. 
Wet-nurse, 164. 

selection of, 165. 
Wetting the bed, 42. 
Whey, wine, 231. 
Window ventilator, 75. 



Yawning, 45. 

Yellow staining of the skin, 252. 



Z. 

Zinc ointment, 135. 



